Director II Medicaid State Operation

Elevance Health•Nashville, TN

9d•Hybrid

About The Position

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.

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.

Nice To Haves

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.

Responsibilities

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.