HCMS Director
Core
Managing utilization and care management processes for Physical and Behavioral Health member populations to ensure delivery of essential services addressing total healthcare needs.
Role type
Director of Health Care Management Services (HCMS)
Builds
Essential healthcare services for member product populations
Domain
US Healthcare / Health Insurance / Utilization Management
Deliverable
client delivery
Required skills
Utilization management, case management, clinical operations, medical policy development, regulatory liaison, quality reporting (HEDIS), cost of care management
Preferred skills
LICSW/LCSW/LPC/Psychiatric RN, Maryland Medicaid expertise, NCQA accreditation experience, Certified Case Manager
Technologies
HEDIS reporting tools, clinical management guidelines systems
Responsibilities
Implement and manage health care management, utilization, cost, and quality objectives; oversee development and execution of medical and case management policies; serve as liaison to state regulatory agencies; support quality initiatives including clinical indicators reporting and focus studies; ensure program compliance and improve consumer experience and quality outcomes.
Seniority
Director level, management