Overview

Summary

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.

Job Description

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.

The Director, Health Services 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 the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.

Required Qualifications

  • Current active and unrestricted Oklahoma RN License OR the ability to obtain an unrestricted RN License in Oklahoma upon hire
  • 8 or more years of technical experience, to include a combination of Utilization Management and Managed Care, and Case Management
  • 5 or more years of leadership experience
  • Must be passionate about contributing to an organization focused on continuously improving consumer experiences
  • Varied clinical experience
  • Intermediate to advanced computer skills and experience with Microsoft Office specifically Power Point, Word, Excel and Outlook.
  • Previous experience with electronic case note documentation and experience with documenting in multiple computer applications/systems.

Preferred Qualifications

  • Master’s Degree
  • Experience working with Medicare and/or Medicaid populations
  • Intermediate to advanced healthcare financial acumen

Additional Information

In order to support the CDC recommendations on social distancing and reduce health risks for associates, members and public health, Humana is deploying virtual and video technologies for all hiring activities. This position may be subject to temporary work at home requirements for an indefinite period of time. These requirements include access to a personal computing device with a camera, a minimum internet connection speed of 10m x 1m, and a dedicated secure home workspace for interview or work purposes. Humana continues to monitor the situation, and will adjust service levels as the coronavirus situation evolves. The following changes are temporary and will be evaluated frequently with the goal of returning to normal operations as soon as possible. Your Talent Acquisition representative will advise on the latest recommendations to protect your health and wellbeing during the hiring process.

Scheduled Weekly Hours

40

Tracking

To Apply: https://www.jobg8.com/Traffic.aspx?KTp74skQKYIxnjy%2flsLJywl