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    Director, Quality - Los Angeles, CA, United States - Elevance Health

    Elevance Health
    Elevance Health Los Angeles, CA, United States

    4 weeks ago

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    Description

    A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management is a benefit-management leader in Illinois.

    Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology, oncology, and post-acute care solutions.

    Carelon Medical Benefits Management Clinical Operations organization is looking to hire a Director of Medical Management .

    This people leader will manage and develop a team of clinical operationsmanagers who will perform clinical reviews for a set of Post Acute Care Utilization Management solutions such as home health, durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).

    This Director will be responsible for day-to-day clinical operations for different solutions, implementingnew solutions, workflows, and process improvement efforts to improve the performance of both business lines.

    Position can work 1 day a week from any Elevance Health US corporate location.

    Accountable for meeting company goals and client deliverables, meeting client SLAs and client Performance guarantees- greatly reducing MBM's financial exposure to PG payouts.

    Develops short/long-term customer care objectives and continuously monitors procedures to ensure these are met by staff. Hires, trains, coaches, counsels, and evaluates performance of direct reports.
    Responsible for staff development/training.
    Responsible for financial planning/budget programs and the coordination of operations expenses. Develop and ensure the continued effectiveness of financial reporting, planning, and infrastructure.
    Promotes continuous quality improvement throughout the organization
    Works with key personnel and subject matter experts across all departments to ensure coordinated management of operational activities.

    Develops, implements and monitors impact of associate engagement activities based on best practices for remote employees, while being mindful of coverage and financial requirements.

    Fosters a culture of collaboration, creative thinking and mutual respect among peers and direct reports.
    Promotes the diversity of the workforce throughout the organization.
    Hires, trains, coaches, counsels, and evaluates performance of direct reports.

    Current active unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States preferred.

    Prior management experience required.
    Leadership experience in a utilization management clinical operations business inside a health plan or a UM/benefits management firm

    • Utilization management or clinical experience with post acute care, especially home health and DME
    • Experience managing productivity with operational tools such as WFM software, Excel, Tableau, Smartsheet, dashboard and report building
    For candidates working in person or remotely in the below locations, the salary* range for this specific position is $113,040 to $203,472

    In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

    The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.


    • The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans.
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