Director II Medical Management

Elevance Health•Atlanta, MO

7d•Hybrid

About The Position

Director II Medical Management 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 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 an accommodation is granted as required by law. Federal Employee Program - FEP , a proud member of the Elevance Health, Inc. family of companies, it is a powerful combination, and the foundation upon which we are creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us, and together we will drive the future of health care. The Director II Case Management is responsible for the strategic leadership and operational oversight of care management programs, including case management, utilization management, disease management, and demand management. This role leads clinical teams to improve member outcomes, drive quality performance (including FEP HEDIS measures), and ensure cost-effective use of healthcare resources. The Director operates in a matrixed environment and is accountable for program execution, process improvement, and compliance with all contractual, regulatory, and accreditation requirements, including NCQA standards. This position oversees care management operations that may range from single-site to large, multi-site, multi-state environments, depending on level and scope.

Requirements

Bachelor’s degree in Nursing and a minimum of 8 years of healthcare experience, including management experience, or an equivalent combination of education and experience.
Current, active, unrestricted RN license in applicable state(s) or U.S. territory required.

Nice To Haves

Master’s degree or advanced degree in nursing, business, or healthcare-related field preferred.
Experience in population health, HEDIS performance, and multi-state or multi-product health plan operations are strongly preferred.

Responsibilities

managing and developing clinical staff
monitoring performance metrics
leading quality improvement initiatives
implementing program and process enhancements
overseeing complex operations across multiple products and clients
engaging with key accounts
leading cross-functional initiatives
driving program design and redesign efforts that impact members
collaborating with internal and external stakeholders to resolve issues
ensuring regulatory compliance
overseeing budgets, resource planning, and special projects
building and sustaining a high-performing team through hiring, coaching, mentoring, and performance management
fostering a culture of accountability, continuous improvement, and clinical excellence