McElhiney has served as a teacher and assistant girls basketball coach at her alma mater, Gleason School, at both the junior high and high school level. Her husband, Joel Ayers, was the head coach. She also served as an assistant at the
University of Tennessee at Chattanooga. She was hired as assistant coach of the Lady Mocs in July 2007. UTC was 29–4 with McElhiney on its bench. In July 2015 she was hired as an assistant girls basketball coach at
Dyersburg High School in
Dyersburg, Tennessee. In May 2021, she was hired as the assistant head coach for
University School of Jackson.
Nashville Rhythm McElhiney became the first female coach of a male professional basketball team in 2004, when she was hired to coach the
American Basketball Association's
Nashville Rhythm. Her coaching career got off to a good start, with the Rhythm achieving a 9–2 record at the start of the season and McElhiney being reported to have the support of the male Rhythm players.
Dontae' Jones, a former
NBA player then with the Rhythm, was quoted as saying, "It's going to go a long way toward how women succeed from here on .... If I can help her continue to raise that bar, then I'm doing my job." Another Rhythm player,
Adam Sonn, commented, "She comes in, and it's just normal. It's just a coach coaching." The Rhythm's season was marred by an incident in which one of the team's co-owners,
Sally Anthony, fired McElhiney in the middle of a game on January 29, 2005, on the grounds that McElhiney was playing
Matt Freije after Anthony insisted that Freije be benched. McElhiney nevertheless finished coaching the game, which the Rhythm won. She was reinstated as coach by decision of the team's other two co-owners before the team's next game. The Rhythm finished with a 21–10 record, qualifying for the playoffs and the chance to host a first-round playoff game. However, the team's owners chose to withdraw the team from the postseason, stating, "We've lost several players and felt we were not ready for the playoffs." McElhiney resigned as coach later the same week. ==Administrative career==