Elevance Health - Atlanta, GA

posted 3 months ago

Full-time - Mid Level
Atlanta, GA
Insurance Carriers and Related Activities

About the position

The Implementation Director for the Clinical Audit Platform at Elevance Health is a pivotal role within Carelon Payment Integrity, a member of the Elevance Health family. This position is designed for a high-performing individual contributor who will act as a Program Director, taking consultative ownership of the migration to a new, modern digital platform. The successful candidate will collaborate closely with the broader Audit team to assess current workflows and identify necessary evolutions in processes. This involves gathering requirements from users and partnering with product and IT teams to define enhancements, implement the new platform, and facilitate the migration of existing work to this new system. Additionally, the Implementation Director will be responsible for developing onboarding and training plans for internal users who will utilize the new audit tool. This role is primarily internal-facing, with the job title of Clinical Programs Director. In this hybrid position, the Implementation Director will work 1-2 days per week from the preferred location in Mason, OH, but candidates from any US Elevance Health corporate work location will also be considered. The role is crucial in ensuring that the implementation process is supported effectively, which includes presenting programs and advising on necessary programmatic changes based on data collected. The Implementation Director will also develop strong relationships with audit line leaders, translating business needs into platform requirements, standard workflows, and operational interfaces. As a super user, trainer, and subject matter expert on the audit platform, this individual will play a key role in resolving operational issues and ensuring the successful adoption of the new system.

Responsibilities

  • Provide support to the implementation process in the presentation of programs and advise on programmatic changes based on data collected.
  • Develop relationships with audit line leaders to translate business needs into platform requirements, standard workflows, and operational interfaces.
  • Serve as a super user, trainer, and subject matter expert on the audit platform, informing the resolution of operational issues.
  • Gather requirements from users and partner with product and IT teams to define enhancements for the new platform.
  • Develop onboarding and training plans for internal users who will perform audit work in the new tool.

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 in healthcare clinical technology and program management.
  • Experience implementing new tools, technology, and digital systems such as platforms.
  • PMP certification is highly preferred.
  • Experience gathering requirements from business users and working with Product/IT teams to translate user stories.
  • 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.
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