Manager I HCMS – Maternal, Child, and Women’s Health Care Management

Elevance Health • Walnut Creek, CA

24d • Hybrid

About The Position

The Manager I HCMS – Maternal, Child, and Women’s Health Care Management is responsible for managing a team of physical and/or behavioral health practitioners responsible for coordinating member service, utilization, access, care management and/or concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services for one or more member product populations of varying medical complexity ensuring the delivery of essential services that address the total healthcare needs of members.

Requirements

• Requires BA/BS and minimum of 5 years of experience in Health Care Management; or any combination of education and experience, which would provide an equivalent background.
• Current active unrestricted RN and any other state or federal requirements that may apply is required.
• Travels to worksite, client locations, and other sites as necessary.

Nice To Haves

• MSN, MPH, MPA, MSW or MBA with Health Care Concentration preferred.
• Prior bedside obstetric, pediatrics, and/or women's health experience is preferred.
• Prior experience in Care Management.
• Prior experience in managing or leading a team or project management is necessary to ensure exceptional attention to detail and an understanding of clinical operations is preferred.
• Excellent written, oral, presentation, and interpersonal communication skills are strongly preferred.
• Proficiency in Microsoft Office products—Excel, Teams, Outlook, PowerPoint, Word—and AI tools is strongly preferred.
• Licensure in CA, NV, and/or WA is preferred.
• Candidates from all states are welcome to apply provided they reside within commuting distance of a Pulse Point office location.

Responsibilities

• Manages and oversees team responsible for delivering maternity and pediatric care management services to members with complex physical and behavioral health conditions.
• Ensures compliance with global program elements as well as contractual or regulatory requirements within aligned markets.
• Develops and implements workflows and protocols in compliance with global programs and regulatory guidelines.
• Assists in identifying opportunities to improve operational efficiencies, clinical quality, and solution performance.
• Analyzes solution specific reports identifying trends over time.
• Coordinates service delivery to include member assessment of physical and psychological factors.
• Partners with providers to establish short and long-term goals that meet the members’ needs, functional abilities, and referral sources requirements.
• Identifies members with potential for high-risk complications.
• Reviews benefit systems and cost benefit analysis.
• Evaluates medical, mental health and substance abuse service for cost containment.
• Supports program compliance and assists in identifying opportunities to improve the customer service and quality outcomes.
• Supports quality initiatives and activities, including adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Benefits

• a comprehensive benefits package
• incentive and recognition programs
• equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements)

What This Job Offers

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