Job Family: Medical and Clinical
Type: Full time
Date Posted: Dec 12, 2023
Reference: JR94125
Description
Location: Iselin, NJ
How you will make an impact:
Responsible for leading the development, implementation, and evaluation of Corporate Medical Policy coding strategies across the enterprise.
Primary duties may include, but are not limited to:
Conceptualizes implementation approaches that consider both the large and varied business issues and objectives across regions and the very detailed considerations of adjudication systems, benefit design, and regulatory environments that also vary by region.
Assesses multiple business and technical factors to identify and evaluate implementation and coding options for specific policies and recommends optimal approach.
Optimizes enterprise solutions for implementation of policy that balances clinical, coding, systems, cost and provider relations elements.
Communicates and monitors the execution of a value-added approach to policy implementation in collaboration with clinical and operations stakeholders in business units.
Develops the quality assurance process to assure accurate code assignment on policies and translation within adjudication systems.
Improvises processes, tools, and measures that standardize and improve performance related to implementation and demonstrate quantifiable value to business units.
Leads the work group and facilitates identification and resolution of local implementation issues.
Minimum Requirements:
Requires a BA/BS degree and a minimum of 5 years of related medical policy experience including prior experience leading large, multi-stakeholder regional or enterprise projects; or any combination of education and experience which would provide an equivalent background.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.