Location
Washington, DC. This role requires associates to be in-office four days per week, fostering collaboration and connectivity while providing flexibility to support productivity and work‑life balance. Alternate locations may be considered.
HCMS Director
The HCMS Director will manage 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 You Will Make An Impact
- Implements and manages health care management, utilization, cost, and quality objectives.
- Ensures program compliance and identifies opportunities to improve 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 eight (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
- RN, LCSW, or LPC preferred.
- National Committee for Quality Assurance (NCQA) accreditation and HEDIS reporting experience preferred.
- MS/MA degree in a health care field or MBA with Health Care concentration preferred.
- Certified Case Manager preferred.
For candidates working in person or virtually in the listed location(s), the salary interval for this position is $121,624 – $182,436.
Locations: District of Columbia.
In addition to salary, Elevance Health offers a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution. Benefits are subject to eligibility requirements.
Elevance Health is an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws. Applicants requiring accommodation to participate in the job application process may contact
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