Requisition ID: 815947
Position:Full-Time
Total Rewards: Benefits/Incentive Information

There’s more to EyeMed than meets the eye. EyeMed is the fastest growing managed vision benefits company in the country with consistent double-digit membership growth! Through our commitment to innovation, we’re reimagining the way employers and their employees think about vision care. We want them to see life to the fullest and experience more of what’s best, not more of the same. And if what’s best hasn’t been done yet, it’s our exceptional and passionate employees driving this change. But, our passion for vision isn’t just about vision insurance benefits. Our employees are proud to support and participate in life-altering global and local missions through our partnership with OneSight, a leading not-for-profit organization with a 100% focus on eradicating the world’s vision crisis.

Your family says a lot about who you are. EyeMed is a key member of the Luxottica family of companies, global leaders in the design, manufacture and distribution of fashion, luxury and sports eyewear. In North America, Luxottica is the home to global brands Ray-Ban, Oakley and many top fashion house brands. Our leading retail brands include LensCrafters, Sunglass Hut, Pearle Vision, and Target Optical.

If you’re passionate about driving innovation and change and interested in a career in the optical and insurance industry, EyeMed wants to start the conversation and help provide you a growth-focused opportunity with America’s fastest growing vision benefits company.

GENERAL FUNCTION

The Sr Manager – Medicaid Provider Operations will lead the efforts to assess and operationalize new Medicaid business and new requirements for existing Medicaid business across the provider operations teams; Provider Data, Provider Reporting and Analytics, Provider Credentialing, Providers Audit and Investigations, and Grievance and Appeals. The Sr Manager will act as the provider operations subject matter expert and point of contact to engage with the business development, implementation, and Medicaid account teams during the RFP and implementation processes. The Sr Manager will identify opportunities to innovate and automate processes using new approaches, tools and methodologies.

MAJOR DUTIES AND RESPONSIBILITIES

• Direct efforts to assess and implement Medicaid requirements for the Provider Data, Provider Reporting and Analytics, Provider Credentialing, Providers Audit and Investigations, and Grievance and Appeal teams.
• Develop and maintain strong working knowledge of Medicaid system and operational processes across all of provider operations.
• Evaluate and manage risk associated with new and non-standard requirements and performance guarantee requests surfacing from new and existing Medicaid business.
• Build Medicaid process documentation and project plans for active provider operations workstreams.
• Lead collaboration with business development, implementation and Medicaid account teams to offer feedback and status, surface roadblocks and propose possible solutions including technology and resource implications.
• Engage the provider operations leaders as needed to strategize how to approach non-standard requirements and partner to drive creative, compliant and scalable solutions.
• Manage relationships with internal and external Medicaid contacts and SMEs to stay apprised of trends and upcoming activities or initiatives, and proactively engage to drive business readiness.
• Lead Medicaid transformation initiative efforts in partnership with IT, provider experience, provider operations teams.

BASIC QUALIFICATIONS

• Bachelor’s degree or equivalent work experience
• 5+ years’ experience in a managed care setting
• 2+ years of Medicaid experience
• Experience in cross-functional strategic development and implementation of complex projects and initiatives
• Experience in provider operations or provider relations
• Positive influencing and collaboration skills at all levels, including executive leadership
• Ability to work under pressure and multi-task
• Strong project management skills
• Analytical, critical thinking skills with emphasis on root-cause analysis

PREFERRED QUALIFICATIONS

• Working knowledge of Excel, Facets, Cura, Filebound and SAP
• High-level understanding of Medicaid managed care regulatory and compliance requirements

Employee pay is determined by multiple factors, including geography, experience, qualifications, skills and local minimum wage requirements. In addition, you may also be offered a competitive bonus and/or commission plan, which complements a first-class total rewards package Benefits/Incentive Information including health benefits, PTO, 401K, paid family leave, tuition reimbursement, and eyewear discounts.

Upon request and consistent with applicable laws, EssilorLuxottica will provide reasonable accommodations to individuals with disabilities who need assistance in the application and hiring process. To request a reasonable accommodation, please call the Luxottica Ethics Compliance Hotline at 1-888-887-3348 (be sure to provide your name and contact information so that we may follow up in a timely manner) or email HRCompliance@luxotticaretail.com.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, gender, national origin, social origin, social condition, being perceived as a victim of domestic violence, sexual aggression or stalking, religion, age, disability, sexual orientation, gender identity or expression, citizenship, ancestry, veteran or military status, marital status, pregnancy (including unlawful discrimination on the basis of a legally protected pregnancy or maternity leave), genetic information or any other characteristics protected by law. Native Americans receive preference in accordance with Tribal Law.