Anticipated End Date:
2026-08-17
Position Title:
Director Enterprise Reimbursement Strategy
Job Description:
Director Enterprise Reimbursement Strategy
Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The Director Enterprise Reimbursement Strategy will be responsible for leading Cost of Care Ideation for Elevance Health contracts with a focus on services managed by Carelon Health, a subsidiary of Elevance Health. Will work cross-functionally with Ideation Leads for other services, aligned to clear and distinct operational archetypes, the associate will vet potential programs including accountability over proper modeling standards, operational assessments, and driving alignment to most appropriate execution entity within the global organization. This role will also take on the Ideation Profiling opportunities across all service types, including those managed directly by Elevance and/or Carelon Health
How you will make an impact:
Development and implementation of strategic initiatives to control unit medical costs.
Evaluation of annual CMS reimbursement guidelines and recommendations as they relate to control over medical claims cost.
Research and develop new contracting and reimbursement methodologies.
Facilitates the communication of activities, emerging trends, and best practices with provider solution leadership across all lines of business.
Directs the daily interaction with and requests for reimbursement subject matter expertise and support.
Oversee and prioritize workflow.
Coordinates with Reimbursement Policy/Edit team as necessary to achieve strategic reimbursement related goals.
Works closely with CoC team on PADU (Preferred/Acceptable/Discouraged/Unacceptable).
Hires, trains, coaches, counsels, and evaluates the performance of direct reports.
Minimum Requirements:
Requires a BA/BS degree in Business, Finance, Economics, or Healthcare Administration and a minimum of 10 years of related experience in broad-based, analytically oriented, managed care payor or provider environment required. Experience must include project management, CMS payment methodology application, and financial/economic business modeling.
Preferred Skills, Capabilities and Experiences:
Advanced knowledge of managed care provider and claims payment systems and process is essential and strongly preferred.
CPA, MBA or other equivalent advanced degree is preferred.
Job Level:
Director
Workshift:
Job Family:
PND > Policy
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.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words 1 the job is posted until 3/13, not through 3/13.
