Become a part of our caring community and help us put health first
 

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.

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.

Use your skills to make an impact
 

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.

Additional Information

• Travel: Up to 5%, possibly out of your home state.
• Workstyle: Remote, work at home.
• Core Workdays & Hours: Typically, 8-5 pm Monday – Friday Eastern Standard Time (EST).
• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.....  

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Scheduled Weekly Hours

40

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.