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Director II Medicaid State Ops, Tennessee

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 II Medicaid State Ops (COO) serves as a key member of the Wellpoint Tennessee Executive Leadership Team and is responsible for the overall operational performance of the health plan. This role provides strategic and operational leadership across all functional areas, ensuring the delivery of high-quality services, regulatory compliance financial stewardship and exceptional member and provider experiences.  This role partners closely with state agency leaders, internal business partners, and market leadership to execute organizational priorities, achieve contractual obligations, and advance Wellpoint’s mission.

How will you make an impact: 

• Develops, directs, plans, and evaluates the goals and objectives for Wellpoint Tennessee. Leads day-to-day health plan operations, ensuring effective execution of strategic priorities and contractual requirements.

• In collaboration with the Plan President, establishes overall standards, policies, and objectives for Health Plan in accordance with applicable regulatory requirements.

• Ensures alignment and support with overall Medicaid Business Unit mission, goals, and objectives.

• Identify operational risks and implement mitigation strategies to ensure continuity, compliance, and performance.

• Partner with clinical leadership to ensure delivery of high-quality person-centered care management solutions, promoting operational efficiencies and reducing administrative burden for Case Managers and LTSS Coordinators.

• Partner with RVP of provider networks to establish strategy for excellence in network operations, ensuring timely and accurate claims payment and overall provider satisfaction.

• Lead implementation of major business initiatives, regulatory changes, and transformation efforts.

• Responsible for local marketing and community relations, network development, provider partnerships, provider relations, medical management, case management and quality management programs, performance management/improvement, budgets, complaints and appeals, regulatory and contractual compliance, monthly financials, and reporting.

• Hires, trains, coaches, counsels, and evaluate performance of direct reports. Foster a culture of accountability, collaboration, innovation and continuous improvement.

• Influence and lead within a highly matrixed environment.

• Drive continuous improvement initiatives focused on efficiency, quality, and value creation, across Medicaid and Medicare programs.

Minimum Requirements:

• Requires a BA/BS in a related field and minimum of 8 years relevant experience, including in-depth experience in the HMO/healthcare field, minimum of 5 years working with Medicaid and/or Medicare programs; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Master’s degree preferred.

•  Demonstrated experience leading large-scale operational functions and cross-functional teams strongly preferred.

• Strong knowledge of Medicaid managed care programs and regulatory requirements strongly preferred.

• Strong understanding of claims payment processes, encounter submission requirements, regulatory reporting, and the operational impact of claims and encounter performance on provider satisfaction, compliance, and financial outcomes strongly preferred.

• Experience working directly with state agencies, regulators, and external stakeholders strongly preferred.

• Experience with LTSS, dual eligible populations, and complex care management programs strongly preferred.

• Knowledge of Tennessee Medicaid (TennCare) programs and regulations strongly preferred.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $148,480 to $256,128

Locations: Illinois, Columbus, OH, and Virginia

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 salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.  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. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. 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. The amount and availability of any bonus, commission, benefits, paid time off, stock, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

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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.