[Hiring] Associate Director, Clinical Strategy and Policy Governance @Humana

Role Description

The Associate Director, Clinical Strategy and Practice develops and implements strategy aimed at:

• Increasing enterprise clinician capacity
• Enhancing clinician recruitment, development, and retention
• Supporting clinician licensure compliance and continuing education

Reporting to the Director, Clinical Strategy & Practice, you will use data-based insights to direct process improvement efforts within the clinical community. You will also relate decisions to resolving complex technical and operational problems within department(s) and could lead multiple managers or specialized professional associates.

The Associate Director, Clinical Strategy & Practice – Policy Governance provides enterprise leadership and oversight for Utilization Management (UM) policy governance, including:

• UM Committee (UMC) functions
• UM letters, including Medicaid adverse determination letters

You will ensure compliant and scalable application of UM standards across programs. The Associate Director leads governance-driven strategy, process improvement, and restructuring efforts to:

• Address inefficiencies
• Reduce regulatory risk
• Improve quality
• Support a sustainable workforce model

This role partners with clinical, compliance, legal, operations, and process improvement leaders to ensure governance decisions are operationalized across markets.

Qualifications

• Bachelor’s degree in healthcare administration, public health, business administration, or a related field
• 3+ years direct management experience
• 5+ years of experience in healthcare operations, utilization management, policy governance, or related areas within a managed care or health plan environment
• Strong knowledge of Medicaid, NCQA, CMS, and state regulatory requirements relevant to utilization management
• Demonstrated experience leading cross-functional projects or governance initiatives in a healthcare setting

Requirements

• UM Committees and Medicaid adverse determination letters
• Process improvement certification (e.g., Lean Six Sigma, PMP)

Benefits

• Medical, dental, and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance
• Many other opportunities

Additional Information

• Workstyle: Remote
• Must be able to work Eastern Time Zone hours
• Travel: 1-2 times annually for onsite meetings
• Scheduled Weekly Hours: 40
• Pay Range: $126,300 - $173,700 per year
• This job is eligible for a bonus incentive plan based on company and/or individual performance