Appeals and Optimization Medical Director - Medicaid

Are you a passionate and driven medical professional with experience in appeals and optimization for Medicaid? Look no further, Elevance Health is seeking a talented Appeals and Optimization Medical Director to join our dynamic team. As a leader in the healthcare industry, we are dedicated to providing high-quality care to our Medicaid patients. In this role, you will have the opportunity to make a meaningful impact by overseeing the appeals and optimization process, ensuring that our patients receive the best care possible. If you have a strong background in Medicaid, a keen eye for detail, and exceptional leadership skills, we want to hear from you. Join us in our mission to improve the health and well-being of our community.

1. Oversee the appeals and optimization process for Medicaid patients to ensure timely and accurate resolution of appeals and maximize patient outcomes.
2. Develop and implement strategies to optimize the appeals process and improve overall patient experience.
3. Work closely with the appeals team to review and analyze appeals data, identify trends, and implement improvement plans.
4. Ensure compliance with all relevant laws, regulations, and guidelines related to Medicaid appeals and optimization.
5. Collaborate with other medical professionals and departments to ensure a coordinated and comprehensive approach to patient care.
6. Provide guidance and support to appeals staff, including training and mentoring, to ensure efficient and effective operations.
7. Stay updated on changes and updates in the Medicaid landscape and proactively identify potential impact on appeals and optimization processes.
8. Participate in meetings and presentations to share insights, recommendations, and outcomes related to appeals and optimization.
9. Engage in continuous quality improvement initiatives to enhance the overall quality of care for Medicaid patients.
10. Serve as a liaison between the organization and external partners, such as insurance companies and government agencies, regarding appeals and optimization processes.

According to JobzMall, the average salary range for a Appeals and Optimization Medical Director - Medicaid in Tampa, FL, USA is between $222,699 and $440,982 per year. This salary range can vary depending on factors such as years of experience, specific job duties, and the size of the company. Additionally, individual negotiation and benefits packages can also impact the final salary offer.

Elevance Health, Inc. is an American health insurance provider. The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and Blue Shield, Empire BlueCross BlueShield in New York State, Anthem Blue Cross in California,Wellpoint, and Carelon.It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2022, the company had 46.8 million members within their affiliated companies' health plans. Prior to June 2022, Elevance Health was named Anthem, Inc.