Director II Medical Management

Elevance Health • St. Louis, MO

4d • Hybrid

About The Position

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
• 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
• Experience in HEDIS performance
• Experience in 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

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 5,001-10,000 employees