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Elevance Health

HCMS Director

Hanover, MD · On-site

$115K - $172K/yr

HCMS Director Location: Maryland This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work ...

Elevance Health

HCMS Director

Hanover, MD · On-site

$115K - $172K/yr

HCMS Director HCMS Director Location: Maryland This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support ...

Elevance Health

HCMS Director

Hanover, MD · On-site

$115K - $172K/yr

HCMS Director Location: Maryland This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work ...

1872 Consulting

Workday HCM Analyst

Boerne, TX · Hybrid

Provides functional and technical support of HCMS. Serves as a primary source for tier 2/tier 3 technical advice, guidance, and support to fellow team members in the utilization of the HCMS and ...

JS Consulting

SAP Project Manager (HCM)

Albany, NY · On-site

... HCMS modernization for a higher education institute. This role requires strong experience with HR systems on the SAP platform. Travel: Occasional statewide travel to various campuses throughout NYS ...

NFI Industries

HRIS Analyst

Trenton, NJ · On-site

$77K - $103K/yr

Provide support for HCMS, including researching and resolving HCMS problems, unexpected results or process flaws; performing scheduled activities; recommending solutions or alternate methods to meet ...

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HCMS Director

Elevance Health

Hanover, MD • On-site

$115K - $172K/yr

Other

Re-posted 3 days ago

Elevance Health rating

7.7

Company rating: 7.7 out of 10

Based on 349 frontline employees who took The Breakroom Quiz

201st of 301 rated insurance

Job description

HCMS Director

Location: Maryland 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.

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.

How will you make an impact:

  • 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.

Minimum 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.

Preferred Skills, Capabilities and Experiences:

  • 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.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $115,080.00 - $172,620.00 USD Annual.

Job Level: Director Equivalent

Workshift: Job Family: MED > Medical Ops & Support (Non-Licensed)

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About Elevance Health

Sourced by ZipRecruiter

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Indianapolis, IN, US

Year founded

2004

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