Manager I HCMS, Louisville, KY

Position Title:

Manager I HCMS, Louisville, KY

Job Description:

The Manager I HCMS is responsible for managing a team of physical and/or behavioral health practitioners responsible for coordinating member service, utilization, access, care management and/or concurrent review to ensure cost effective utilization of health, mental health, and substance abuse services for one or more member product populations of varying medical complexity ensuring the delivery of essential services that address the total healthcare needs of members. Knowledgeable about EPSDT and Medicaid Managed Care. Hires, trains, coaches, and evaluates performance of direct reports.

Hours are M-F 8-5 pm EST, Weekends and Holidays on call.

Must be commutable to the Louisville, KY office and Frankfort, KY for State meetings. Will work 1-2 days in the office.

How you will make an impact:

• Manages and oversees team responsible in case finding and coordinating cases that involve comorbid conditions.
• Coordinates service delivery to include member assessment of physical and psychological factors.
• Partners with providers to establish short- and long-term goals that meet the member's needs, functional abilities, and referral sources requirements.
• Identifies members with potential for high-risk complications.
• Reviews benefit systems and cost benefit analysis.
• Evaluates medical, mental health and substance abuse service for cost containment.
• Supports program compliance and assists in identifying opportunities to improve the customer service and quality outcomes.
• Supports quality initiatives and activities, including adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Requirements:

BA/BS and minimum of 5 years of experience in Health Care Management; or any combination of education and experience, which would provide an equivalent background.

Current active unrestricted RN in the state of KY or Compact license.

Assets and preferred qualifications:

Utilization Management experience

Power Point experience for presentations

MSN, MPH, MPA, MSW or MBA with Health Care Concentration.

Certified Case Manager Certification (CCM)

Job Level:

Manager

Workshift:

1st Shift (United States of America)

Job Family:

MED > Licensed/Certified - Other

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and 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 - and Elevance Health approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World's Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 [email protected] for assistance.