Healthcare Management Services (hcms) Director Senior

Healthcare Management Services (HCMS) offiziellen Senior Director – Elevance HealthLocation: Requires in‑office presence 3 days per week with hybrid flexibility for candidates within commutable distance. Candidates outside this area will not be considered unless an accommodation is granted.Responsibilities Accountable to plan executive or executive team member depending on plan size/complexity; involved in developing strategic vision, goals, and objectives for medical management.Serve as liaison to state regulatory agencies; drive direction of plan related to cost of care and other directives.Ensure program compliance and identify opportunities to improve consumer experience and quality outcomes.Direct and provide leadership for designing, developing, and implementing integrated medical management programs to meet demographic and epidemiological needs of serviced populations.Partner with other health plan/corporate leaders to develop and deliver innovative care management services, root‑cause analyses, and solutions to achieve quality outcomes.Direct Healthcare Management Program including disease management, case management, and utilization management.Partner with Provider Relations, Quality Management, Health Promotions, and Community Relations to develop and implement effective provider communications, quality assurance, and member outreach programs.Provide expert consultation to local plan staff on benefits interpretation, utilization, and quality management matters.Ensure compliance with National Committee for Quality Assurance (NCQA) and state/federal program requirements.Minimum Qualifications BA/BS degree in a health care field and a minimum of 10 years clinical work experience including prior management experience; or an equivalent combination of education and experience.Previous experience with NCQA accreditation and HEDIS reporting required.Preferred Skills & Experience RN, LCSW, or LPC preferred.MS/ amén degree in a health care field or MBA with Health Care concentration preferred.Benefits and compensation include competitive pay, bonus opportunities, comprehensive health benefits, and professional development support.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 identity or expression, marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status protected by applicable federal, state, or local laws.

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