HCMS Director (Behavioral Health - Medicaid)

Elevance Health • Richmond, VA

15d • Hybrid

About The Position

HCMS Clinical Director (Behavioral Health - Medicaid) Hybrid 2 : 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. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location will not be considered for employment, unless an accommodation is granted as required by law. LOCATION: Must reside in the state of Virginia and travel to state meetings in Richmond, VA regularly. The HCMS Director 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, ensuring the delivery of essential services that address the total healthcare needs of members. Primary duties may include, but are not limited to: Directs and provides leadership for designing, developing, and implementing integrated medical management program to meet the demographic and epidemiological needs of the populations served. 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 behavioral health, disease management, case management, and utilization management. Implements and manages health care management, utilization, cost, and quality objectives. Partners with Provider Relations, Quality Management, Health Promotions, and Community Relations to develop and implement effective provider communications, quality assurance, and member outreach programs. 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.

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.

Nice To Haves

• RN, LCSW, LPC or other behavioral health clinical licensure strongly preferred.
• Experienced Behavioral Health clinician strongly preferred.
• Physical health preferred.
• Knowledge of Virginia Medicaid strongly preferred.
• Experience in Case Management strongly preferred.
• National Committee for Quality Assurance (NCQA) accreditation and HEDIS reporting experience preferred.
• MS/MA degree in a health care field or MBA with Health Care concentration preferred.

Responsibilities

• Directs and provides leadership for designing, developing, and implementing integrated medical management program to meet the demographic and epidemiological needs of the populations served.
• 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 behavioral health, disease management, case management, and utilization management.
• Implements and manages health care management, utilization, cost, and quality objectives.
• Partners with Provider Relations, Quality Management, Health Promotions, and Community Relations to develop and implement effective provider communications, quality assurance, and member outreach programs.
• 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.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Director