Manager I, HCMS at Elevance Health in Buffalo, New York

Job Description:

LOCATION: This is a hybrid role, and you must be within 50 miles/1 hour commute of an eligible PulsePoint location.


HOURS: Monday through Friday, 8:00 am - 5:00 pm, eastern time


TRAVEL: There is the potential for very limited travel.


The Manager I HCMS is responsible for managing a team of physical health practitioners responsible for coordinating member service, utilization, access, care management and/or concurrent review to ensure cost effective utilization of health, 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.


Primary duties may include, but are not limited to:

• 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 members' needs, functional abilities, and referral sources requirements. Identifies members with potential for high risk complications.
  
  


• Reviews benefit systems and cost benefit analysis.
  
  


• Evaluates medical services 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.
  
  

• Requires 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 license issued by the state of New York is required.
  
  

• Proficiency in computer applications including Microsoft Word, PowerPoint and Excel is a must.
  
  


• At least 2 years of people management (leading a team) experience is a must.
  
  


• Previous knowledge of various disease processes is very helpful.