Healthcare Management Services; HCMS Director Senior

Anticipated End Date

Healthcare Management Services (HCMS) Director Senior

Location:

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. Alternate locations may be considered if the candidate resides within a commutable 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 an accommodation is granted as required by law.

The Healthcare Management Services (HCMS) Director Senior is responsible for the development, implementation, and oversight of integrated Medical Management of more than one member population type of Physical Health and/or Behavioral Health with varying degrees of medical complexity.

• Oversees case and utilization management execution/decision making for managed member populations.
• Is accountable to plan executive or executive team member dependent on plan size/complexity and is involved in the development of the strategic vision, goals, and objectives for medical management.
• 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.
• Directs and provides leadership for designing, developing, and implementing integrated medical management program to meet the demographic and epidemiological needs of the populations serviced.
• Partners with other health plan/corporate leaders to develop and deliver innovative care management services, root cause analyses and solutions to achieve quality outcomes.
• Directs Healthcare Management Program including disease management, case management, and utilization management.
• Partners with Provider Relations, Quality Management, Health Promotions, and Community Relations to develop and implement effective provider communications, quality assurance, and member outreach programs.
• Provides expert consultation to local plan staff on benefits interpretation and utilization and quality management matters.
• Ensures support for compliance with National Committee for Quality Assurance (NCQA) and assures compliance with state and or federal program requirements.

• Requires a BA/BS degree in a health care field and a minimum of 10 years clinical work experience including prior management experience; or any combination of education and experience which would provide an equivalent background.
• Previous experience with NCQA accreditation and HEDIS reporting required.

• RN, LCSW, or LPC preferred. MS/MA degree in a health care field or MBA with Health Care concentration preferred.

Director Equivalent

1st Shift (United States of America)

MED >
Medical Ops & Support (Non-Licensed)

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.

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.

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…