Anticipated End Date:

Position Title:

Job Description:

Program Consultant Quality/Member Rights Specialist Wisconsin Family Care

Location: Wisconsin

Field: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. 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, unless accommodation is granted as required by law. 

The Program Consultant Quality/Member Rights Specialist will be responsible for member rights and performs quality reporting to DHS, including Critical Incident reporting. Program consultants typically support business strategies through an integrated portfolio of external client facing projects or initiatives.

How you will make an impact:

• Performs quality reporting to DHS, including Critical Incident reporting.
• Serves as a member advocate and works directly with members to assist with navigating care, appeals and grievances, maintaining income eligibility, and other member rights-related needs.
• Ensures the Member Rights Specialist/quality function remains fully independent from other health plan functions, consistent with contractual requirements.
• Works with members, income maintenance agencies, ADRCs, and other partners to gather information needed to maintain member eligibility.
• Executes Member Rights Specialist and quality reporting activities within contractually-defined timelines and requirements to reduce risk of non-compliance and associated penalties.
• Manages the development, approval, implementation and compliance of on-going external client facing programs.
• Develops program budget.
• Ensures program meets its stated objectives.
• Provides subject matter expertise in response to day to day business issues.
• Researches applicable subject matter practices and remains aware of industry trends.
• Manages relationships and partners with corporate and regional business areas.
• Coordinates training related to the external client facing program.
• Develops program success measures and performs periodic assessments of external client facing program success.

Minimum Requirements:

• Requires a BA/BS in a related field and minimum of 3 years experience in external client facing program management; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Graduate degree, professional designation related to field or project management experience preferred.

Job Level:

Workshift:

Job Family:

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.