Director Health Services

Profile

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

Current active and unrestricted OHIO RN License OR the ability to obtain an unrestricted RN License in OHIO upon hire

8 or more years of technical experience, combination of Utilization Management and Case Management in Medicaid or combined experience in Medicaid and Medicare

3-5 years of leadership experience

Must be passionate about contributing to an organization focused on continuously improving consumer and provider 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

Medicaid market implementation experience

Certified Professional in Health Care Quality (CPHQ)

Certified in Health Care Quality and Management (CHCQM)

Additional Information

Position can be Work from Home Ohio, with 25% travel to Columbus

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com