Humana
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Humana Healthy Horizons is seeking an Associate Director, Utilization Management Nursing, who utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Associate Director, Utilization Management Nursing, requires a solid understanding of how organization capabilities interrelate across department(s) The Associate Director, Utilization Management Nursing, uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for members.
Required Qualifications: Licensed Registered Nurse (RN) with no disciplinary action. 3+ years of management/leadership experience. 4+ years of utilization management experience, preferably in prior authorization. Experience leading UM trend initiatives. Experience with Medicaid plans. Advanced Proficiency in Microsoft Office Products (i.e. Word, Excel, PowerPoint, Teams). Proven problem-solving skills (i.e. adept at research, analysis, and data driven decision making/generating creative solutions). Ability to operate in a fast-paced environment under tight deadlines and in ambiguous situations. Must work hours within the eastern standard time zone. Preferred Qualifications: Licensed Registered Nurse (RN) with compact license with no disciplinary action. Certified Managed Care Certification. Experience leading multi-state teams. Behavioral health UM experience. Bachelor's Degree. Work at Home Requirements: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
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The Associate Director coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Decisions are typically related to identifying and resolving complex technical and operational problems within department(s) and could lead multiple managers or highly specialized professional associates.
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Basic
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$34
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$79
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$149
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