Health Care Management Director — Hybrid (MD)

elevancehealth; Hanover (MD); Hybrid; USD 115,000 - 173,000; Full time

Benefits offered by this job

Comprehensive benefits package

401(k) + match

Stock purchase plan

Wellness programs

Job summary

Elevance Health is seeking an HCMS Director in Maryland to lead utilization and care management across health populations. The role emphasizes delivering essential services, promoting quality and cost-effective care, and ensuring program compliance through collaboration with internal teams and external stakeholders.

The candidate should have substantial clinical leadership experience, with a BA/BS in a health-related field and 8+ years in management.

Qualifications

• BA/BS in a health care field; 8+ years clinical experience including management
• Experience in utilization management or case management
• Strong collaboration with internal and external stakeholders

Responsibilities

• 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 development and execution of medical and case management policies.
• Assists in developing clinical management guidelines.
• Ensures medical management activities are contracted, reviewed and reported.
• Supports quality initiatives including HEDIS reporting.
• Serves as liaison to state regulatory agencies and drives cost of care directions.

Skills

Leadership

Stakeholder collaboration

Clinical operations

Utilization management

Project management

Education

BA/BS in health care

8+ years clinical experience

Tools

NCQA knowledge

Job description

Elevance Health is seeking an HCMS Director in Maryland to lead utilization and care management across health populations. The role emphasizes delivering essential services, promoting quality and cost-effective care, and ensuring program compliance through collaboration with internal teams and external stakeholders.

The candidate should have substantial clinical leadership experience, with a BA/BS in a health-related field and 8+ years in management.