- Engages in the development and implementation of integrated medical management programs across the different member population types covered by the health plan.
- Ensures continued compliance with specific medical management standards.
- Engages in the development process for medical and clinical management policy, procedures, and strategies.
- Evaluates medical, mental health, and substance abuse services for cost containment, to include complex/specialized member populations.
- Ensures program deliverables and compliance by monitoring established goals and implementing improvement strategies.
- Takes the lead within assigned area on ensuring the unit is positioned and prepared to execute on quality initiatives and activities including clinical indicators reporting, focus studies, HEDIS reporting and adherence to National Committee for Quality Assurance (NCQA) standards.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
- BA/BS in a related Health/Nursing field and minimum of 6 years of experience as aligned to appropriate license which includes 3 years prior management experience; or any combination of education and experience, which would provide an equivalent background.
- Current active unrestricted RN, LCSW, LPC, LMHC or other accepted license (as allowed by applicable state laws) and any other state or federal requirements that may apply is required.
- Masters in related Health/Nursing field preferred.
- Certified Case Manager Certification preferred.
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Manager, Utilization Management Department - Washington, United States - Elevance Health
Description
Anticipated End Date:Position Title:
Manager, Utilization Management Department
Job Description:
This position is located at our Washington, DC office with a requirement of 1-2 days onsite.
The Mgr II HCMS is responsible for managing a team of physical and/or behavioral health practitioners in the development, implementation, and coordination of a comprehensive integrated Medical Management program designed to manage health outcomes in a highly complex member populations with varying degrees of medical complexity and acuity. Participates in case and/or utilization management execution/decision making for managed member populations. Primary duties may include, but are not limited to:
Manager
Workshift:
Job Family:
MED > Licensed/Certified - Other
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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
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. 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 for assistance.
