Director Enterprise Reimbursement Strategy

This role requires associates to be in-office 3 days per week, combining structured office engagement with the flexibility of virtual work. Alternate locations may be considered if candidates reside within a commuting distance from an office.

About the role

The Director Enterprise Reimbursement Strategy will lead Cost of Care Ideation for Elevance Health contracts, focusing on services managed by Carelon Health, a subsidiary of Elevance Health. This role involves cross-functional collaboration with Ideation Leads for other services, vetting potential programs, ensuring proper modeling standards, conducting operational assessments, and driving alignment to the most appropriate execution entity within the global organization. The role also includes Ideation Profiling opportunities across all service types managed by Elevance and/or Carelon Health.

Responsibilities

• Development and implementation of strategic initiatives to control unit medical costs.
• Evaluation of annual CMS reimbursement guidelines and recommendations as they relate to control over medical claims cost.
• Research and develop new contracting and reimbursement methodologies.
• Facilitate communication of activities, emerging trends, and best practices with provider solution leadership across all lines of business.
• Direct daily interaction with and requests for reimbursement subject matter expertise and support.
• Oversee and prioritize workflow.
• Coordinate with the Reimbursement Policy/Edit team to achieve strategic reimbursement-related goals.
• Work closely with the CoC team on PADU (Preferred/Acceptable/Discouraged/Unacceptable).
• Hire, train, coach, counsel, and evaluate the performance of direct reports.

Requirements

• BA/BS degree in Business, Finance, Economics, or Healthcare Administration.
• Minimum of 10 years of related experience in a broad-based, analytically oriented, managed care payor or provider environment.
• Experience must include project management, CMS payment methodology application, and financial/economic business modeling.

Preferred Qualifications

• Advanced knowledge of managed care provider and claims payment systems and processes.
• CPA, MBA, or other equivalent advanced degree.

Benefits

• Market-competitive total rewards including merit increases, paid holidays, and Paid Time Off.
• Incentive bonus programs (unless covered by a collective bargaining agreement).
• Medical, dental, vision, short and long-term disability benefits.
• 401(k) with company match and stock purchase plan.
• Life insurance, wellness programs, and financial education resources.

Schedule

Hybrid Workforce Strategy: Associates are required to work at an Elevance Health location at least once per week, with specific onsite expectations discussed during the hiring process.