Associate Director, Health Services Nursing

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🔥 7 minutes ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

💵 $104k - $143k / year

⏰ Full Time

🟠 Senior

👔 Director

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• responsible for driving excellence in care management (CM) and utilization management inpatient (UM) clinical operations • oversee the assessment and evaluation of members' needs and requirements to achieve and maintain optimal wellness • guide members/families toward and facilitate interaction with resources appropriate for the care and well-being of members • provide supervision and daily guidance to care management and utilization management team members • monitor and evaluate performance metrics and outcomes to ensure the effectiveness and quality of care management activities • develop and implement departmental policies and procedures in accordance with contract changes and/or updates

🎯 Requirements

• An active, unrestricted Registered Nurse (RN) license in the State of South Carolina with no disciplinary actions • Bachelor's degree in nursing (BSN) or a related healthcare field • Three (3) or more years of clinical leadership experience in utilization management • Three (3) or more years of care management leadership experience • Three (3) or more years of Medicaid-related experience • Familiarity with InterQual, MCG, and/or ASAM criteria • Comprehensive knowledge of Microsoft Office applications, including PowerPoint, Word, Excel, and Outlook • Knowledge of Medicaid regulatory requirements and National Committee for Quality Assurance (NCQA) standards

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • short-term and long-term disability • life insurance • many other opportunities