HCMS Director (Clinical Psychologist)

Elevance Health • Seven Fields, PA

7d • Hybrid

About The Position

HCMS Director (Clinical Psychologist) JR179550 Location: Seven Fields, Pennsylvania 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. 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. The HCMS Director is responsible for managing the utilization and care management programs for members of varying Behavioral Health complexity ensuring the delivery of essential services that address the total healthcare needs of members.

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

• Pennsylvania Ph.D or Psy.D clinical license strongly preferred.
• National Committee for Quality Assurance (NCQA) accreditation and HEDIS reporting experience strongly preferred.
• Strong leadership capabilities preferred.

Responsibilities

• Implements and manages health care management, utilization, cost, case management 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 programs, policies, procedures, and guidelines; assists in developing clinical management guidelines.
• Ensures medical management and case management activities are contracted, compliant, reviewed and reported.
• Supports quality initiatives and activities including clinical indicators reporting, focus studies, and HEDIS reporting.
• Serves as liaison to primary contractors/clients, and state regulatory agencies.
• Ensures program compliance and identifies opportunities to improve the consumer experience and quality outcomes.
• Attends state meetings regularly in Pennsylvania.

What This Job Offers

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