HCMS Director — Health Plan Clinical Ops (Maryland Hybrid)

The Elevance Health Companies, Inc.; Hanover (MD); Hybrid; USD 115,000 - 173,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401(k) contribution

Hybrid work arrangement

Job summary

Elevance Health seeks an HCMS Director in Maryland to lead health care management, utilization, cost and quality objectives. In-office 3 days a week with flexible work and policy-based hybrid arrangements.

The role drives medical management policies, partners with stakeholders, ensures regulatory compliance and quality outcomes, and guides NCQA/HEDIS reporting. A senior clinician with strong leadership is preferred.

Qualifications

• Requires BA/BS degree in a health care field with 8+ years of clinical management experience.
• Experience in case management with healthcare programs is preferred.

Responsibilities

• 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.

Skills

Case management

Clinical operations

Utilization management

Quality improvement

Stakeholder partnership

Education

BA/BS in health care field

Job description

Elevance Health seeks an HCMS Director in Maryland to lead health care management, utilization, cost and quality objectives. In-office 3 days a week with flexible work and policy-based hybrid arrangements.

The role drives medical management policies, partners with stakeholders, ensures regulatory compliance and quality outcomes, and guides NCQA/HEDIS reporting. A senior clinician with strong leadership is preferred.