HCMS Director

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.

About the role

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.

Responsibilities

• 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.
• Aids in developing clinical management guidelines.
• Safeguards medical management activities are contracted, reviewed, and reported.
• Supports quality initiatives and activities including clinical indicators reporting, focus studies, and HEDIS reporting.
• Serves as a liaison to state regulatory agencies.
• Drives direction of the plan related to cost of care and other plan directives.

Requirements

• 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.

Preferred Skills, Capabilities And Experiences

• LICSW, LCSW, LPC, or, Psychiatric RN strongly preferred.
• Advanced knowledge of Iowa 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.

Benefits

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.

Pay

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.

Schedule

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.