Healthcare Management Services (HCMS) Director Senior

Elevance Health • Lubbock, TX

2d • Hybrid

About The Position

Healthcare Management Services (HCMS) Director Senior 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 the candidate resides within a commutable 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 Healthcare Management Services (HCMS) Director Senior 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. How you will make an impact: Oversees case and utilization management execution/decision making for managed member populations. Is accountable to plan executive or executive team member dependent on plan size/complexity and is involved in the development of the strategic vision, goals, and objectives for medical management. 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. Directs and provides leadership for designing, developing, and implementing integrated medical management program to meet the demographic and epidemiological needs of the populations serviced. 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 disease management, case management, and utilization management. Partners with Provider Relations, Quality Management, Health Promotions, and Community Relations to develop and implement effective provider communications, quality assurance, and member outreach programs. Provides expert consultation to local plan staff on benefits interpretation and utilization and quality management matters. Ensures support for compliance with National Committee for Quality Assurance (NCQA) and assures compliance with state/and or federal program requirements.

Requirements

• Requires a BA/BS degree in a health care field and a minimum of 10 years clinical work experience including prior management experience; or any combination of education and experience which would provide an equivalent background.
• Previous experience with NCQA accreditation and HEDIS reporting required.

Nice To Haves

• RN, LCSW, or LPC preferred.
• MS/MA degree in a health care field or MBA with Health Care concentration preferred.

Responsibilities

• Oversees case and utilization management execution/decision making for managed member populations.
• Is accountable to plan executive or executive team member dependent on plan size/complexity and is involved in the development of the strategic vision, goals, and objectives for medical management.
• 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.
• Directs and provides leadership for designing, developing, and implementing integrated medical management program to meet the demographic and epidemiological needs of the populations serviced.
• 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 disease management, case management, and utilization management.
• Partners with Provider Relations, Quality Management, Health Promotions, and Community Relations to develop and implement effective provider communications, quality assurance, and member outreach programs.
• Provides expert consultation to local plan staff on benefits interpretation and utilization and quality management matters.
• Ensures support for compliance with National Committee for Quality Assurance (NCQA) and assures compliance with state/and or federal program requirements.

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
• Number of Employees: 5,001-10,000 employees