Member Solutions Manager Jobs in Highlands Ranch, CO

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Manager I - Clinical Solutions Manager

Hybrid 2: This role requires associates to be in-office3days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

• Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unlessaccommodationis granted as required by law.

Work Schedule: This position is scheduled for 40 hours per week across 5 days. The schedule must include Saturday, Sunday is a designated day off, and one weekday off will be determined based on business needs with associate preference taken into consideration.

The Manager I - Clinical Solutions Manager leads a team of clinical and non-clinical staff responsible for managing work after physician review. This role ensures that complex cases are handled accurately, on time, and in accordance with company policies and regulatory requirements. The manager works closely with physician reviewers, the Provider Network team, Client Services and other departments to ensure cases move efficiently through the review process and that providers and members receive timely, high-quality service.

The Manager I - Clinical Solutions Manager also researches and resolves complex escalated cases that require quick turnaround. This role partners with physicians and other internal teams to remove barriers, improve workflows, solve operational issues, and support better outcomes for providers, members, and the organization

How you will make an impact:

• Ensures adherence to medical policy and member benefits in providing service that is medically appropriate, high quality, and cost effective.

• Areas managed may include authorizing inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or community resources.

• Applies clinical knowledge to work with facilities and providers for care-coordination.

• May also manage appeals for services denied.

• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Minimum Requirements:

• Requires a HS diploma or equivalent and a minimum of 5 years acute care clinical experience; or any combination of education and experience, which would provide an equivalent background.

• Requires current, active, valid unrestricted RN license to practice as a health professional within the scope of practice in applicable state(s) or territory of the United States.

Preferred Skills, Capabilities and Experiences:

• Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills strongly preferred.

• Strong leadership skills, including coaching, performance management, and development of direct reports.

• Experience managing complex escalations and driving timely issue resolution.

• Strong collaboration skills with physicians, providers, and cross-functional business partners.

• Knowledge of medical policy interpretation, utilization management, and care coordination processes.

• Strong decision-making, prioritization, communication, and analytical skills.

For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

If this job is assigned to any Government Business Division entity, the applicant and incumbent fall under a `sensitive position' work designation and may be subject to additional requirements beyond those associates outside Government Business Divisions. Requirements include but are not limited to more stringent and frequent background checks and/or government clearances, segregation of duties principles, role specific training, monitoring of daily job functions, and sensitive data handling instructions. Associates in these jobs must follow the specific policies, procedures, guidelines, etc. as stated by the Government Business Division in which they are employed.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $94,000 - $162,150

Location(s): Nevada, Colorado, Virginia

In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stockpurchaseand 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 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.

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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.

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 and Influenza. 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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.