Senior Director, Healthcare Management Services
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Indianapolis • Connecticut • Kentucky • United States
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Job Level
About the role
- Oversees case and utilization management execution/decision making for managed member populations.
- Is accountable to plan executive or executive team member dependent on plan size/complexity and is involved in the development of the strategic vision, goals, and objectives for medical management.
- 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.
- Directs and provides leadership for designing, developing, and implementing integrated medical management program to meet the demographic and epidemiological needs of the populations serviced.
- 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 disease management, case management, and utilization management.
- Partners with Provider Relations, Quality Management, Health Promotions, and Community Relations to develop and implement effective provider communications, quality assurance, and member outreach programs.
- Provides expert consultation to local plan staff on benefits interpretation and utilization and quality management matters.
- Ensures support for compliance with National Committee for Quality Assurance (NCQA) and assures compliance with state/and or federal program requirements.
Requirements
- Requires a BA/BS degree in a health care field and a minimum of 10 years clinical work experience including prior management experience; or any combination of education and experience which would provide an equivalent background.
- Previous experience with NCQA accreditation and HEDIS reporting required.
- RN, LCSW, or LPC preferred.
- MS/MA degree in a health care field or MBA with Health Care concentration preferred.
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short and long term disability benefits
- 401(k) + match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
case managementutilization managementdisease managementquality managementstrategic planningroot cause analysisprogram compliancehealth care managementHEDIS reportingNCQA accreditation
Soft skills
leadershipcommunicationcollaborationproblem-solvingconsultationorganizational skillsstrategic vision developmentconsumer experience improvementquality outcomes focusstakeholder engagement
Certifications
RNLCSWLPC