Associate Director, Utilization Management Nursing

Description

Humana Gold Plus Integrated 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 organizational capabilities interrelate across departments.

Responsibilities

The Associate Director, Utilization Management (UM) Nursing uses clinical knowledge, communication skills, and independent critical thinking skills to interpret criteria, policies, and procedures providing 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 and makes decisions typically related to identifying and resolving complex technical and operational problems within departments and may lead multiple managers or highly specialized professional associates.

Key responsibilities include but are not limited to:

• Operational responsibility for UM functions.
• People management responsibility of 10+ nurse direct reports.
• Act as point of contact to coordinate pilots/ changes/initiatives across UM functions.
• Manage escalations from providers/members and internal partners.
• Review metrics across UM spectrum and manage any unfavorable trends.
• Represent the region externally (UM) to Acute/Post-Acute and other healthcare systems.
• Delegation oversight along with other duties as assigned.

Required Qualifications

• Bachelor's Degree.
• 6+ years of technical experience.
• 2+ years of management experience.
• Licensed Registered Nurse (RN) in the State of Illinois with no disciplinary action.
• Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook.
• Strong background working in broad scope Utilization Management roles.
• Ability to travel up to 10%.
• 3+ years of experience working in a managed care or acute hospital setting.
• 3+ years of experience working with physician groups and ancillary vendors.
• Must be focused on engagement, able to grow a team, drive initiatives and works well with senior leadership.

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.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Preferred Qualifications

• BSN or bachelor’s degree in nursing.
• Process improvement or project management experience preferred.
• Experience working with MCG/Milliman or InterQual.
• Background working with Medicare and Medicaid members.
• Passionate about contributing to an organization focused on continuously improving consumer experiences.

Additional Information

Direct Reports: Up to 20 Associates.

Hours: Typically, Monday-Friday 8:00 AM - 5:00 PM CST (must be flexible with schedule if needed).

Work Location and Travel: Remote (role requires travel up to 10% to Humana’s office location).

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Montage, 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 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.

Social Security Task

Alert: Humana values personal identity protection.  Please be aware that applicants being considered for an interview will be asked to provide a social security nu