HCMS Director

Elevance Health•Hanover, MD

2d•$115,080 - $172,620•Hybrid

About The Position

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.

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

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

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.
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.