Director II – Medicaid State Operation

Responsibilities

Develops, directs, plans, and evaluates the goals and objectives for Wellpoint Tennessee

Leads day-to-day health plan operations

Ensures effective execution of strategic priorities and contractual requirements

Collaborates with the Plan President to establish overall standards, policies, and objectives

Ensures alignment and support with overall Medicaid Business Unit mission

Identifies operational risks and implements mitigation strategies

Partners with clinical leadership for person-centered care management solutions

Partners with RVP of provider networks for network operations strategy

Leads implementation of major business initiatives and transformation efforts

Responsible for local marketing, community relations, network development, and compliance

Requirements

Requires a BA/BS in a related field

Minimum of 8 years relevant experience

In-depth experience in the HMO/healthcare field

Minimum of 5 years working with Medicaid and/or Medicare programs

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 and encounter submission requirements

Experience working directly with state agencies and regulators 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

ATS Optimization Keywords
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Hard Skills

health plan operations

Medicaid programs

Medicare programs

claims payment processes

encounter submission requirements

LTSS

dual eligible populations

complex care management programs

Tennessee Medicaid

regulatory requirements

Soft Skills

leadership

collaboration

strategic planning

risk management

communication

community relations

network development

operational execution

cross-functional team leadership

person-centered care management

Certifications & Qualifications

BA/BS

Master’s degree

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