Business Strategy Plan Director- MedEx Management

Elevance Health•Miami, FL

41d•Hybrid

About The Position

Business Strategy Plan Director (Business Stat Plan Dir) 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. 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. Alternate locations may be considered if candidate resides within a commutable distance from an office. The Business Strategy Plan Director- MedEx (Medical Expense) Management is responsible for managing the development and implementation of medical expense management initiatives for assigned Carelon Health business unit. How you will make an impact: Oversees the development and execution of new and innovative initiatives specific to the Carelon Health, enterprise or one or more health plans, managing rising costs and enhancing the company's market competitiveness. Understands all aspects of the business and partners with executive leadership to define strategy and successful criteria for the future. Identifies and develops best practices and cost of care improvement processes around physician, hospital and ancillary network contract negotiation strategies, utilization management efforts, new products, annual benefit design participation, and operations. Oversees the identification of potential cost of care savings opportunities through complex analytics, development of action plans, benefits and risk assessments and partners with the actuarial team to develop and ensure accurate savings quantification. Champions cost of care initiatives, negotiates for human capital resources, and partners with care management, network, claims & operational teams, IT, and business partners. Builds and leverages relationships to provide innovative solutions to complex business problems. Proposes opportunities to improve results based on continuous needs assessment. Responsible for the development implementation and monitoring of line of business planning and project activities. Travels to worksite and other locations as necessary.

Requirements

Requires a BA/BS degree in a related field and a minimum of 10 years of related experience including prior leadership experience and 3 to 5 year strategic planning; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

MBA, MHA and PMP or Six Sigma Green Belt strongly preferred.
Financial, Business, and Leadership acumen strongly preferred.
Prior experience with managed care, trend & healthcare analytics, provider networks, claims, finance, and operations strongly preferred.
Healthcare payer experience strongly preferred.
Cost of Care knowledge and experience preferred.
Executive presence an the ability to influence preferred.

Responsibilities

Oversees the development and execution of new and innovative initiatives specific to the Carelon Health, enterprise or one or more health plans, managing rising costs and enhancing the company's market competitiveness.
Understands all aspects of the business and partners with executive leadership to define strategy and successful criteria for the future.
Identifies and develops best practices and cost of care improvement processes around physician, hospital and ancillary network contract negotiation strategies, utilization management efforts, new products, annual benefit design participation, and operations.
Oversees the identification of potential cost of care savings opportunities through complex analytics, development of action plans, benefits and risk assessments and partners with the actuarial team to develop and ensure accurate savings quantification.
Champions cost of care initiatives, negotiates for human capital resources, and partners with care management, network, claims & operational teams, IT, and business partners.
Builds and leverages relationships to provide innovative solutions to complex business problems.
Proposes opportunities to improve results based on continuous needs assessment.
Responsible for the development implementation and monitoring of line of business planning and project activities.
Travels to worksite and other locations as necessary.