HCMS Director

HCMS Director

Location:

Maryland. This role requires associates to be in office 3 days 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.

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 an accommodation is granted as required by law.

The HCMS Director is responsible for managing the utilization or care management process for one or more member product populations of Physical Health and/or Behavioral Health of varying medical complexity, ensuring the delivery of essential services that address the total healthcare needs of members.

• Implements and manages health care management, utilization, cost, and quality objectives.
• Ensures program compliance and identifies opportunities to improve the customer service and quality outcomes.
• Oversees the development and execution of medical and case management policies, procedures, and guidelines.
• Assists in developing clinical management guidelines.
• Ensures medical management activities are contracted, reviewed and reported.
• Supports quality initiatives and activities including clinical indicators reporting, focus studies, and HEDIS reporting.
• Serves as liaison to state regulatory agencies. Drives direction of the plan related to cost of care and other plan directives.
• Ensures program compliance and identifies opportunities to improve the consumer experience and quality outcomes.

• Requires a BA/BS degree in a health care field and a minimum of 8 years clinical experience including prior management experience; or any combination of education and experience which would provide an equivalent background.

• LICSW, LCSW, LPC, or Psychiatric RN strongly preferred.
• Advanced knowledge of Maryland Medicaid strongly preferred.
• 5+ years case management and clinical operations experience strongly preferred.
• Extensive utilization management review experience strongly preferred.
• Ability to partner and collaborate with key external and internal stakeholders strongly preferred.
• National Committee for Quality Assurance (NCQA) accreditation and HEDIS reporting experience preferred.
• Certified Case Manager preferred.

For candidates working in person or virtually in the below location(s), the salary range for this specific position is $ - $ USD annual.

Locations:
Maryland

In addition to your salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase plan, and 401(k) contribution (all benefits are subject to eligibility requirements). The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected under applicable pay equity laws.

COVID-19 and influenza vaccination is required for all new candidates in certain member‑facing roles. If you are not vaccinated, your offer may be rescinded unless you provide an acceptable explanation.

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 elevancehealthj for assistance.

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.