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The Associate Director, Clinical Strategy and Practice develops and implements strategy. This strategy drives targeted initiatives aimed at increasing enterprise clinician capacity, enhancing clinician recruitment, development, and retention, and 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. This oversight also includes UM Committee (UMC) functions and 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 and, and 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.

Key Responsibilities

• Provide end-to-end leadership for Medicaid UM governance, including UMC and UM policy design, implementation, and sustainability.
• Ensure UM policies and governance decisions align with NCQA, CMS, and state requirements and are applied consistently across markets.
• Establish standardized UM governance processes to support compliance, scalability, and audit readiness.
• Provide governance oversight for Medicaid UM letters, including adverse determinations, to ensure quality and compliance.
• Standardize and optimize UM letter workflows, roles, handoffs, and quality controls to support efficiency and workforce sustainability.
• Lead and partner across clinical strategy, UM operations, compliance, legal, quality, and IT to advance centralized UM strategy and sustainable operating models.

Use your skills to make an impact
 

Required 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.

Preferred Qualifications:

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

Additional Information:

Additional Information

·         Workstyle: Remote

·         Must be able to work Eastern Time Zone hours

·         Travel: 1-2 times annually for onsite meetings

Interview Format

As part of our hiring process for this opportunity, we will use an interviewing technology called HireVue to enhance our hiring. HireVue allows us to quickly connect and gain valuable information from you about your relevant experience at a time that is best for your schedule.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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. 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.

 

$126,300 - $173,700 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our