Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical-expense spending.

Carelon Payment Integrity's Complex & Clinical Audit Team is looking to hire an Implementation Director, Clinical Audit Platform.  This high-performing individual contributor will work as a Program Director by providing consultative ownership of the work migration to a new modern digital platform.    S/he will work with the broader Audit team to understand how we work today and how the work needs to evolve, gather requirements from users, and partner with product and IT teams to define enhancements, implement the new platform, and migrate current work to the new platform.  S/he will develop onboarding and training plans for the platform's internal users who will perform audit work in the new tool.  (Internal facing job title is a Clinical Programs Director)  

This hybrid position will work 1-2 days per week from our Mason, OH work location as the preferred location, however, we will consider candidates near any US Elevance Health corporate work location.     

How you will make an impact:

• Provides support to the implementation process in the presentation of these programs and advises on programmatic changes needed based on data collected.

• Develops relationships with audit line leaders and works with them to translate business needs to platform requirements, standard workflows, and operational interfaces.

• Serves as a super user, trainer, and subject matter expert on the audit platform and informs resolution of operational issues.

Requires a BS in nursing or other related clinical area and minimum of 6 years related experience including program development, marketing, and clinical practice; or any combination of education and experience, which would provide an equivalent background.

Highly preferred skills and experiences:

-Healthcare clinical technology and program management experience 

-Experience implementing new tools, technology, and digital systems such as platforms  

-PMP certification

-Experience gathering requirements from business users and working with Product/IT teams to translate those user stories 

-Experience with Payment Integrity and Complex and Clinical Audit experience such as Hospital Bill Audit (HBA), Diagnosis Related Group (DRG) audits, Itemized Bill Review (IBR), and Ancillary/Specialty Audits 

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

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 elevancehealthjobssupport@elevancehealth.com for assistance.