Utilization Review Clinician (RN, PT, OT) - Oregon
WellSkySalary not specified
- Full Time
- Junior (1 to 2 years)
Humana
National Utilization Management Director, Clinical Strategy and Practice
Not SpecifiedCompensation
Senior (5 to 8 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Managed Care, Health InsuranceIndustries
Requirements
Candidates must be a Registered Nurse (RN) with unrestricted licensure or an independent licensed clinical social worker, and possess 2-5 years of previous senior leadership experience in the healthcare industry. They should have at least 3 years of experience in Medicaid or healthcare Utilization Management, with a focus on outpatient care, and demonstrate expertise in process development, strategic planning, and program implementation.
Responsibilities
The National Utilization Management Director, Clinical Strategy and Practice for Medicaid will oversee the deployment of Utilization Management (UM) processes and workflows for new Medicaid states, standardize UM processes for existing markets, oversee operations of existing market centralization, establish and maintain governance for UM structure, policies, and procedures, drive implementation of new market initiatives, design and execute new workflows, develop strategic plans to streamline UM operations, lead UM-related workstreams for RFPs, and provide oversight and coordination of DSNP strategy and programs.
Skills
Utilization Management
Clinical Strategy
Healthcare Operations
Medicaid Compliance
Process Standardization
Workflow Design
Strategic Planning
Cross-department Collaboration
Governance
Humana
Health insurance provider for seniors and military
About Humana
Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.
Key Metrics
Louisville, KentuckyHeadquarters
1961Year Founded
IPOCompany Stage
Social Impact, HealthcareIndustries
10,001+Employees