Job Type






Manager Delegation Oversight (Health Claims / Regulatory ... Columbus

Elevance Health

Elevance Health Columbus GA Georgia

1 week ago

**Manager Delegation Oversight (Health Claims / Regulatory / Accreditation)**

+ Job Family: Enterprise Operations...

+ Type: Full time

+ Date Posted:Mar 08, 2023

+ Req #: JR57498
• *Location:**

+ California, Cerritos

+ Texas, Austin

+ Colorado, Denver

+ Colorado, Colorado Springs

+ California, Los Angeles

+ Texas, Texas

+ Virginia, Virginia

+ Colorado, Colorado

+ California, Woodland Hills

+ Ohio, Mason

+ California, Walnut Creek

+ Georgia, Atlanta

+ Georgia, Georgia

+ Ohio, Cincinnati

+ Indiana, Indianapolis

+ Florida, Tampa

+ Ohio, Ohio

+ Florida, Florida

+ California, Costa Mesa

+ Indiana, Indiana

+ California, Sacramento

+ Texas, Houston

+ Virginia, Richmond

+ Texas, Grand Prairie

+ California, Rancho Cordova

+ Texas, Fort Worth

+ California, California

+ California, Palo Alto

+ Virginia, Norfolk
• *Description**

Manager Delegation Oversight (Health Claims / Regulatory / Accreditation) JR57498
• *Location:** Remote

The **Manager Delegation Oversight** is responsible for managing the oversight of all delegated activities to ensure compliance of all plans contracted delegated entities (Medicare, Medicaid and Commercial), ensuring that these perform the delegated functions in accordance with the plan's requirements, and the Medicaid and Medicare Contract requirements. This includes compliance with state and federal rules and regulations as they relate to the delegated function(s), Fraud and Abuse Prevention Programs, HIPAA Privacy and Security Regulations, and the American Recovery and Reinvestment Act of 2009 (ARRA). Primary duties may include, but are not limited to:

+ Identifies and initiates continuous quality improvements within the Delegation Oversight Unit.

+ Implement and maintain a comprehensive delegation oversight program which entails all the aspects of delegation in compliance with State and Federal regulations, Accreditation and supporting policies and procedures.

+ Serves as the subject matter expert in interpreting requirements to delegates and ensuring overall areas for delegation are functional and in compliance.

+ Collaborates with Legal, Provider Administration and Provider Relation in the development, maintenance, and review of all delegated entities Delegation Contract Amendment to assure compliance with state and federal regulations, CMS, Medicare, Medicaid Requirements and Plan reporting and oversight requirements related to the delegated function.

+ Hires, trains, coaches, counsels, and evaluates performance of direct reports.
• *Minimum Requirements:**

+ BA/BS and minimum of 7 years' experience in managed care; or any combination of education and experience, which would provide an equivalent background.

+ 5 - 7 years' combined experience managing and/or processing claims with knowledge of regulatory and/or Accreditation requirements.
• *Preferred Qualifications:**

+ Strong Leadership/managerial experience.

+ Audit experience within Provider Operations related to Claims processing and the associated rules and regulations which govern that activity.

+ Working knowledge of all lines of business. Medicare a plus.

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $112,800 to $203,040.

Locations: California; Colorado

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws _._
• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
• *Be part of an Extraordinary Team**

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Elevance Health approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [Email available when viewing the job] for assistance.

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+ EEO Policy Statement

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Columbus GA USA

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