Director, Health Services
Posted on: 27 Feb 2021
Roswell, GA
Job Description
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.
Responsibilities
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
* Graduate from an accredited School of Nursing, with at least 5 years of clinical experience.
* Current, valid, and active license to practice as a Registered Nurse in the state of employment
* 8 or more years of technical experience, to include a combination of Utilization Management, and Case Management
* Knowledgeable in utilization review, medical terminology, appropriate levels of care, treatment, modalities, statues, and healthcare delivery models
* 5 or more years of leadership experience
* Must be passionate about contributing to an organization focused on continuously improving consumer experiences
* 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 populations
Additional Information
Scheduled Weekly Hours
40
Humana
Louisville, KY
Humana Inc., together with its subsidiaries, operates as a health and well-being company in the United States. The company offers medical and supplemental benefit plans to individuals. It also has contract with Centers for Medicare and Medicaid Services to administer the Limited Income Newly Eligible Transition prescription drug plan program; and contracts with various states to provide Medicaid, dual eligible, and long-term support services benefits.
In addition, the company provides commercial fully-insured medical and specialty health insurance benefits comprising dental, vision, and other supplemental health and voluntary insurance benefits; financial protection products; and administrative services only products to individuals and employer groups, as well as military services, such as TRICARE South Region contract.
Further, it offers pharmacy solutions, provider services, predictive modeling and informatics services, and clinical care services, such as home health and other services to its health plan members, as well as to third parties. As of December 31, 2018, the company had approximately 17 million members in medical benefit plans, as well as approximately 6 million members in specialty products. Humana Inc. was founded in 1961 and is headquartered in Louisville, Kentucky.
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IndustryHealthcare
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No. of Employees41,600
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Website
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Jobs Posted1359
