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Job Description:

Director II Medical Management

Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Federal Employee Program - FEP, a proud member of the Elevance Health, Inc. family of companies, it is a powerful combination, and the foundation upon which we are creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us, and together we will drive the future of health care.

The Director II Case Management is responsible for the strategic leadership and operational oversight of care management programs, including case management, utilization management, disease management, and demand management. This role leads clinical teams to improve member outcomes, drive quality performance (including FEP HEDIS measures), and ensure cost-effective use of healthcare resources. The Director operates in a matrixed environment and is accountable for program execution, process improvement, and compliance with all contractual, regulatory, and accreditation requirements, including NCQA standards. This position oversees care management operations that may range from single-site to large, multi-site, multi-state environments, depending on level and scope.

How you will make an Impact:

• Responsibilities include managing and developing clinical staff, monitoring performance metrics, leading quality improvement initiatives, and implementing program and process enhancements.

• The Director may also oversee complex operations across multiple products and clients, engage with key accounts, lead cross-functional initiatives, and drive program design and redesign efforts that impact members.

• Additional responsibilities include collaborating with internal and external stakeholders to resolve issues, ensuring regulatory compliance, and overseeing budgets, resource planning, and special projects.

• The Director is responsible for building and sustaining a high-performing team through hiring, coaching, mentoring, and performance management, while fostering a culture of accountability, continuous improvement, and clinical excellence.

• Strong leadership, communication, analytical, problem-solving, and facilitation skills are essential.

Requirement Qualifications:

• Bachelor’s degree in Nursing and a minimum of 8 years of healthcare experience, including management experience, or an equivalent combination of education and experience.

• Current, active, unrestricted RN license in applicable state(s) or U.S. territory required.

Preferred Skills, Capabilities, and Experiences:

• Master’s degree or advanced degree in nursing, business, or healthcare-related field preferred.

• Experience in population health, HEDIS performance, and multi-state or multi-product health plan operations are strongly preferred.

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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.

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.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.