Ohio Medicaid Program Manager - Hybrid

Elevance Health; Columbus (OH); Hybrid; USD 93,000 - 139,000; Full time

Benefits offered by this job

Comprehensive benefits

401(k) + matching

Equity stock purchase plan

Incentive programs

Job summary

Elevance Health is seeking a Program Manager for Ohio MyCare based in Columbus. In this hybrid role, you will manage a portfolio of external client facing projects related to Medicaid claims configuration, rate changes, compliance and contract updates, with in-office presence 1–2 days per week.

You will collaborate with claims, provider experience, utilization management, regulatory and call center leads to ensure timely regulatory reporting, end-to-end claims processes, and strong program

Qualifications

• Requires a BA/BS and minimum of 5 years external client facing experience in program/project management; or any combination of education and experience to provide an equivalent background.

Responsibilities

• Work collaboratively with claims teams, provider experience, utilization management, regulatory and call center leads to resolve issues related to claims policies, reimbursement, codes requiring authorizations, and provider complaints.
• Accountable for on time delivery of regulatory reports related to claims (e.g., Prompt Pay, Claims Disputes).
• Manage and coordinate development, approval, implementation and compliance of ongoing external client facing programs.
• Research applicable subject matter practices and stay aware of industry trends.
• Oversee end-to-end claims process and provider payment compliance.
• Serve as operational liaison with the state of Ohio, Provider Experience, and executive leadership.

Education

BA/BS degree

Graduate degree preferred

Job description

Elevance Health is seeking a Program Manager for Ohio MyCare based in Columbus. In this hybrid role, you will manage a portfolio of external client facing projects related to Medicaid claims configuration, rate changes, compliance and contract updates, with in-office presence 1–2 days per week.

You will collaborate with claims, provider experience, utilization management, regulatory and call center leads to ensure timely regulatory reporting, end-to-end claims processes, and strong program