Director, Health Services

Employment Type: Full time

Position Overview

Become a part of our caring community and help us put health first. We are seeking an experienced and dedicated Director, Health Services to join our team. The Director, Health Services utilizes clinical nursing skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. This role requires an in-depth understanding of how organization capabilities interrelate across the function or segment. This is a key leadership role within the WI Market for the clinical/medical function.

This leadership role is responsible for utilizing advanced clinical expertise, strong communication abilities, and independent critical thinking to interpret and apply criteria, policies, and procedures to ensure members receive the most appropriate treatment, care, or services. The Director, Health Services coordinates and communicates with providers, members, and other stakeholders to facilitate optimal care and outcomes.

Key Responsibilities

• Interpret and apply clinical criteria, policies, and procedures to deliver the highest quality care and services to members.
• Collaborate and communicate effectively with providers, members, and other relevant parties to coordinate care and resolve complex issues.
• Lead the Prior Authorization/Utilization Management, Medicaid Care Management, and Nurse Practitioner units for the clinical/medical service area.
• Lead the implementation of new and updated programs and large-scale projects, including projects designed to reduce the cost of care or improve the quality of care, ensuring alignment with organizational goals and strategies.
• Oversee and improve technical and operational procedures and processes to drive performance and support organizational objectives.
• Participate in the development and execution of strategic plans and budgets for the entire health services function in Wisconsin.
• Responsible for leading and managing a team of 20-40 professionals in each unit.
• Travel to various offices throughout the State of WI - 15% of your time.

Use your skills to make an impact.

Required Qualifications

• Master’s Degree in Nursing, Public Health, Healthcare Administration, or a related degree required.
• Registered Nurse in the State of Wisconsin in good standing (or the ability to obtain quickly).
• At least 8 years of experience in Prior Authorization/Utilization Management, Medicaid Care Management, and/or Nurse Practitioner.
• Minimum of 5 years of management experience leading people.

Preferred Qualifications

• Preference given to those who reside within the State of Wisconsin or those willing to relocate to WI.
• Familiarity with the Humana WI Medicaid care management system.
• Ability to lead and work within a team-based environment.

Additional Information

Workstyle: Home Hybrid: Associates Home office environment is their primary work location where the majority of their work week will be spent, but they will use Humana office space occasionally for collaboration and other face-to-face needs.

Travel: 15% throughout the State of WI.

Typical Work Days/Hours: Monday – Friday, 8:30 am – 5:00 pm CST.

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 connection can be used only if approved by leadership. * 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. * 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.