Become a part of our caring community
 

The Associate Director, Process Improvement leads strategic initiatives that enhance clinical and operational workflows across care management and utilization management programs. You will serve as a key liaison between Clinical Health Services, IT, and Operations to design, improve, and resolve technical and process-related solutions that support quality, compliance, and member outcomes.
You will establish the strategic direction for process improvement efforts, prioritizes initiatives across a portfolio of work, and guides teams in execution to ensure alignment with organizational goals and regulatory requirements. The Associate Director plays a critical role in translating clinical needs into scalable operational and technical solutions that improve efficiency and effectiveness across teams.

Key Responsibilities

• Establish and lead the strategic roadmap and priorities for process improvement initiatives supporting Clinical Health Services
• Serve as a liaison between Clinical Health Services, IT, and Operations to translate clinical needs into effective system and workflow solutions
• Guide and direct teams in prioritizing initiatives, defining next steps, and executing complex, cross-functional work
• Lead the identification and resolution of complex clinical, operational, and technical challenges
• Oversee and develop a team of professionals, providing clear direction, accountability, and performance guidance
• Lead and influence cross-functional stakeholders, including senior leadership, to align priorities and drive outcomes
• Ensure processes support compliance with regulatory, contractual, and accreditation requirements (e.g., CMS, NCQA)
• Drive end-to-end process mapping, redesign, and standardization for care management and utilization management workflows
• Evaluate and implement technology and system enhancements that improve clinical and operational performance
• Manage competing priorities across the organization, ensuring focus on highest-impact initiatives
• Support the integration and continuous improvement of onboarding processes and compliance-related training requirements to ensure teams are prepared to meet expectations
• Build and maintain strong relationships with internal stakeholders, including clinical leaders and market partners

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree required
• 3+ years of experience in process improvement, operations, or technical program support (healthcare environment preferred)
• 3+ years of leadership experience, including direct team oversight
• Experience supporting or partnering with care management, utilization management, or clinical operations teams
• Demonstrated ability to set strategic direction, prioritize initiatives, and lead teams through execution of complex programs
• Proven ability to lead and influence cross-functional teams and stakeholders
• Strong analytical skills with the ability to interpret data and translate insights into actionable improvements
• Experience developing and operationalizing strategy
• Strong communication skills with ability to translate between clinical, technical, and business audiences
• Ability to manage multiple priorities in a fast-paced, matrixed environment
• Medicaid and/or managed care experience
• Must reside in Ohio, Kentucky or in bordering state within driving distance of Humana Waterside (Louisville, KY)

Preferred Qualifications

• Clinical background or healthcare experience (e.g., RN, LCSW, or other clinical discipline) strongly preferred
• Working knowledge of care management and/or utilization management workflows, including assessments, care planning, and authorization processes
• Understanding of clinical documentation standards and regulatory/accreditation requirements (e.g., CMS, NCQA)
• Experience supporting clinical systems or platforms used in care management or utilization management
• Experience in workflow design, process re-engineering, and clinical process optimization
• Experience with tools such as QuickBase or similar platforms
• Bilingual

Additional Information

• Travel to the Humana Waterside building (Louisville, KY) for meetings and trainings required.

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.<