Elevance Health - Norfolk, VA

posted 3 months ago

Full-time - Mid Level
Norfolk, VA
Insurance Carriers and Related Activities

About the position

Carelon Payment Integrity, a member of the Elevance Health family, is seeking an Implementation Director for its Complex & Clinical Audit Team. This role is pivotal in leading the migration to a new modern digital platform, ensuring that the transition is smooth and effective. The Implementation Director will act as a Program Director, taking consultative ownership of the work migration process. This involves collaborating with the broader Audit team to assess current workflows and identify necessary evolutions. The successful candidate will gather requirements from users and partner with product and IT teams to define enhancements, implement the new platform, and facilitate the migration of existing work to this new system. In addition to overseeing the technical aspects of the platform implementation, the Implementation Director will also be responsible for developing onboarding and training plans for internal users who will utilize the new audit tool. This role is essential in ensuring that all users are well-equipped to perform their audit work effectively in the new environment. The position is hybrid, requiring 1-2 days per week at the Mason, OH location, although candidates from other Elevance Health corporate locations in the U.S. will also be considered. The Implementation Director will make a significant impact by supporting the implementation process, advising on necessary programmatic changes based on data collected, and developing strong relationships with audit line leaders. This collaboration will help translate business needs into platform requirements, standard workflows, and operational interfaces. As a super user, trainer, and subject matter expert on the audit platform, the Implementation Director will also play a key role in resolving operational issues as they arise.

Responsibilities

  • Provide consultative ownership of the work migration to a new digital platform.
  • Collaborate with the Audit team to understand current workflows and necessary evolutions.
  • Gather requirements from users and partner with product and IT teams to define enhancements.
  • Implement the new platform and migrate current work to it.
  • Develop onboarding and training plans for internal users of the new audit tool.
  • Support the implementation process and advise on programmatic changes based on data collected.
  • Build relationships with audit line leaders to translate business needs into platform requirements.
  • Serve as a super user, trainer, and subject matter expert on the audit platform.

Requirements

  • Bachelor's degree in nursing or a related clinical area.
  • Minimum of 6 years of related experience including program development, marketing, and clinical practice.
  • Experience gathering requirements from business users and working with Product/IT teams.

Nice-to-haves

  • Healthcare clinical technology and program management experience.
  • Experience implementing new tools, technology, and digital systems such as platforms.
  • PMP certification.
  • Experience with Payment Integrity and Complex and Clinical Audit, including Hospital Bill Audit (HBA), Diagnosis Related Group (DRG) audits, Itemized Bill Review (IBR), and Ancillary/Specialty Audits.

Benefits

  • Health insurance coverage
  • 401k retirement savings plan
  • Paid holidays
  • Flexible scheduling options
  • Professional development opportunities
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