HCMS Clinical Director (Behavioral Health - Medicaid)

Hybrid 2: 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 will not be considered for employment, unless an accommodation is granted as required by law.

LOCATION: Must reside in the state of Virginia and travel to state meetings in Richmond, VA regularly.

The HCMS Director is responsible for the development, implementation, and oversight of integrated Medical Management of more than one member population type of Physical Health and/or Behavioral Health with varying degrees of medical complexity. Oversees case and utilization management execution/decision making for managed member populations, ensuring the delivery of essential services that address the total healthcare needs of members. Primary duties may include, but are not limited to:

• Directs and provides leadership for designing, developing, and implementing integrated medical management program to meet the demographic and epidemiological needs of the populations served.

• Partners with other health plan/corporate leaders to develop and deliver innovative care management services, root cause analyses and solutions to achieve quality outcomes.

• Directs Healthcare Management Program including behavioral health, disease management, case management, and utilization management.

• Implements and manages health care management, utilization, cost, and quality objectives.

• Partners with Provider Relations, Quality Management, Health Promotions, and Community Relations to develop and implement effective provider communications, quality assurance, and member outreach programs.

• 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 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, LPC or other behavioral health clinical licensure strongly preferred.  

• Experienced Behavioral Health clinician strongly preferred.

• Physical health preferred.

• Knowledge of Virginia Medicaid strongly preferred.

• Experience in Case Management strongly 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.

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.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and 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 who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.