Director II Medical Management

Anticipated End Date:
2025-03-24

Position Title:
Director II Medical Management

Job Description:

Director II Medical Management

Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles from either the Tampa or Miami Elevance Health PulsePoint office locations.

The Director II of Medical Management is responsible for managing an environment of larger, more significant scope, complexity and change in multiple operations centers. This role also focuses on enhancing quality outcomes for members, optimizing their benefits, and ensuring the efficient utilization of resources.

How you will make an impact:

• Oversees care management operations across a wide range of products, clients and states including meetings with key major account clients.
• Leads and participates in cross functional corporate teams which design and implement new care management programs that may impact multiple lines of business.
• Develops and implements process and program redesigns.
• Leads multiple teams of clinicians charged with promoting quality member outcomes, to optimize member benefits, and to promote effective use of resources
• May direct multiple medical management programs including utilization management, case management, demand management and disease management programs, which typically support multiple lines of business.
• May also manage appeals for services denied.
• Staff size is typically large, located in multiple sites and/or states and utilizes multiple systems.
• Ensures adherence to all contract, regulatory and accreditation requirements.
• Develops short/long-term objectives and monitors processes and procedures to ensure consistency with the enterprise and compliance with state and federal regulations.
• Collaborates with matrix Care Management partners (such as IM or PE&C) to resolve issues or find solutions.
• Manages budget and special projects.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Minimum Requirements:

• Requires BS in nursing or related health care field and minimum of 8 years of experience in a health care environment (i.e. acute care) which includes prior management experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• MHA, MBA or advanced degree preferred.
• Medicare Utilization Management experience preferred.
• CMS audit experience preferred.
• Health plan accreditation experience preferred.
• Comfortable with data and and technologically savvy preferred.

Job Level:
Director

Workshift:

Job Family:
MED > Licensed Nurse

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 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.