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. The Associate Director, Utilization Management Nursing requires a solid understanding of how organization capabilities interrelate across department(s).
The Associate Director, Utilization Management Nursing uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. 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 department(s), and could lead multiple managers or highly specialized professional associates.
This position will require working onsite in the Centennial, CO office approximately 30% of the time. Some travel may also be required for departmental meetings.
Registered Nursing license free of restrictions
Bachelor's Degree or work related experience
At least 10 years of varied clinical nursing experience
5+ years of management experience
5+ years of experience working with Physician Groups and ancillary vendors
5+ years working in a managed care setting
Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook
Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance for Humana systems is 10Mx1M
Ability to provide a designated workspace; free from distractions with the ability to secure any protected information.
Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10 panel drug test
Process improvement or project management experience preferred
Background working in utilization management
Experience working with MCG/Milliman or Interqual
Background working with Medicare/Medicaid members
The following policy applies ONLY to associates working in the state of Arizona: Humana is committed to providing a safe and healthy work environment and to promoting the health and well-being of its associates. Effective April 1, 2011, Humana has adopted a tobacco-free hiring policy that will promote a healthier workplace and will not hire users of tobacco and nicotine products. If you have any questions, please consult with your recruiter.
Scheduled Weekly Hours
Equal Opportunity Employer
It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.
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