[Hiring] Associate Director, Health Services Nursing @Humana

Role Description

The Associate Director, Health Services Nursing is responsible for driving excellence in utilization management (UM) clinical operations through process improvement initiatives, process development, market enablement, targeted process audits, and training facilitation.

• Oversees new market implementations and leads inter-rater reliability (IRR) processes.
• Ensures adherence to relevant policies and regulations.
• Collaborates across clinical and operational teams to advance best practices, support strategic growth, and optimize performance.
• Leads the development, optimization, and continuous improvement of UM processes and workflows.
• Evaluates market readiness and operational requirements, developing strategies to address identified gaps.
• Provides expertise and leadership necessary to assess market needs and coordinate cross-functional efforts.
• Ensures compliance with regulatory requirements, industry best practices, and organizational standards.
• Owns and supports inter-rater reliability (IRR) processes, promoting consistency in clinical decision-making.
• Conducts targeted process audits to identify improvement opportunities and mitigate risks.
• Designs and refines UM policies and procedures, directs process improvement projects, and prepares performance reports for senior leadership.
• Facilitates training sessions, workshops, and collaborative meetings to engage stakeholders.
• Monitors regulatory changes and industry trends to inform process and policy updates.
• Drives continuous process improvement initiatives that enhance efficiency, quality, and member experience within UM.

Qualifications

• An active, unrestricted, Registered Nurse (RN) license.
• Five (5) or more years of professional experience in the health care industry and/or in utilization management/utilization review.
• Two (2) or more years of formal leadership experience.
• Progressive leadership experience hiring, training, and managing associates.
• Highly adept at managing processes from concept to completion ensuring on-time, on-budget, and on-target results.
• Proficiency in analyzing and interpreting data trends.
• Experience in reviewing and analyzing financial, quality, and utilization data and analytics.
• Project management experience.
• Comprehensive knowledge of all Microsoft Office applications, specifically Excel and PowerPoint.
• Ability to use a variety of electronic information applications/software programs including electronic medical records.
• Ability to identify, structure, and solve business problems.
• Excellent interpersonal, organizational, written, and oral communication and presentation skills.

Requirements

• Workstyle: This is a remote position.
• Travel: This role may require up to 10% travel for onsite meetings.
• Typical Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
• Direct Reports: Up to 10 associates.
• WAH Internet Statement: Minimum download speed of 25 Mbps and upload speed of 10 Mbps required.
• Employees who live and work from Home in specific states will receive a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
• Interview Format: Use of HireVue technology for interviewing.
• Scheduled Weekly Hours: 40.

Benefits

• Competitive benefits that support whole-person well-being.
• 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 and many other opportunities.

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

• $104,000 - $143,000 per year.
• This job is eligible for a bonus incentive plan based on company and/or individual performance.