Associate Director, Utilization Management Nursing

Employment Type: Full time Scheduled Weekly Hours: 40 Pay Range: $115,200 - $158,400 per year

Position Overview

Become a part of our caring community and help us put health first. The Associate Director, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. This role requires a solid understanding of how organization capabilities interrelate across departments. The Associate Director, Utilization Management Nursing uses clinical knowledge, communication skills, and independent critical thinking to interpret criteria, policies, and procedures to provide the best and most appropriate treatment, care, or services for members. This role 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 departments and could lead multiple managers or highly specialized professional associates.

Use Your Skills to Make an Impact

Requirements

• Bachelor's Degree or equivalent experience
• 6 or more years of clinical experience
• 2 or more years of management experience
• Licensed Registered Nurse (RN) in the appropriate state with no disciplinary action

Preferred Qualifications

• Must be passionate about contributing to an organization focused on continuously improving consumer experience

Responsibilities

• Utilize clinical nursing skills for coordination, documentation, and communication of medical services and benefit administration determinations.
• Interpret criteria, policies, and procedures using clinical knowledge, communication skills, and critical thinking.
• Coordinate and communicate with providers, members, and other parties to facilitate optimal care and treatment.
• Identify and resolve complex technical and operational problems within departments.
• Potentially lead multiple managers or highly specialized professional associates.

Location Information

• Location Type: Work will be performed in the State of Indiana.
• Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Work From Home (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.
• Satellite, cellular, and microwave connections can be used only if approved by leadership.
• Employees who live and work from Home in the states of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees 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.

SSN Alert Statement

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website.

Modern Hire Statement

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

Company Information

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