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. The Director, Health Services 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 information.

HireVue

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.

SSN Alert

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.

 

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$138,900 - $191,000 per year

 

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

Description of Benefits

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 healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

​
Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.