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Anthem, Inc. Director I Medicaid State Ops in Mendota Heights, Minnesota

Description

SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.

This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health care companies and a Fortune Top 50 Company.

Director of Operations for MN will:

  • Establishes state strategic plans and objectives to meet business unit goals.

  • Assumes leadership role in implementing corporate initiatives, including special project planning and budget management.

  • Leads program development to ensure members, network providers, and community partners successfully participate in programs.

  • Ensures all policies and procedures related to Operations are compliant with all applicable laws and regulations governing the State Sponsored Business.

  • Provides coordinated analysis and market solutions to issues.

  • Guides implementation of programs and strategies.

  • Collaborates with senior management to develop and implement new programs to enhance relationships with key stakeholders and to promote programs and services.

  • Resolves programmatic challenges related to program operations including member issues, provider claims and provider network.

  • Manages projects and issues across departmental and divisional lines to facilitate timely resolution.

  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

  • Plans, directs, and secures the resources (people, material, data and support) for staff to effectively accomplish operational needs and strategic initiatives.

  • Maintains appropriate staffing levels and provides oversight of indirect reporting associates.

  • Motivates associates to accomplish goals and objectives.

  • Develops and implements budget and a strong team through training and effective organizational development practices.

Specifically, in the structure of the BCBS Alliance,

  • The Director of Operations works with BCBS:

  • To ensure that DHS, CMS, and BCBS contractual requirements are clearly defined and documented

  • To ensure that Anthem and BCBS shared service solutions are validated and monitored for ongoing requirement compliance

  • To ensure that DHS, CMS, and BCBS contractual requirement changes and modifications are clearly defined and documented

  • To ensure that BCBS business requirements are clearly defined and documented

  • To ensure that there are effective business information exchange systems and processes between Amerigroup and BCBS including Service Now and other applications

  • The Director of Operations works with Anthem Growth Partners (shared services) to ensure that the MN Plan regulatory and business requirements are met and monitored. This work will be with teams including but not limited to:

  • Government business division COO

  • Anthem Network Services

  • Anthem and GBD IT

  • Anthem regulatory and compliance

  • GBD finance

  • The Director of Operations works across Amerigroup and BCBS and is responsible for the effectiveness of the cost of care program including but not limited to:

  • Program Integrity and SIU

  • System configuration accuracy

  • Reimbursement policy

Qualifications

Requires:

  • BA/BS degree in a related field;

  • 8 years management experience in the health care field;

  • 3 years health plan operations experience

  • or any combination of education and experience, which would provide an equivalent background.

Master’s degree preferred.

Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and has been named a 2019 Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

REQNUMBER: PS42393

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