Anticipated End Date:
2026-07-10
Position Title:
HCMS Director
Job Description:
HCMS Director
Location: Iowa 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.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The HCMS Directoris 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:
Preferred Skills, Capabilities and Experiences:
LICSW, LCSW, LPC, or, Psychiatric RN strongly preferred.
Advanced knowledge of Iowa 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.
Job Level:
Director Equivalent
Workshift:
Job Family:
MED > Medical Ops & Support (Non-Licensed)
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words 6 the job is posted until 3/13, not through 3/13.
