Health Services Director Medicaid

Profile

Description

The Health Services Director leads teams of nurses and behavior health professionals responsible for care management. The Director, Care Management requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

Responsibilities

The Director, Health Services (HSD) coordinates and communicates with providers, members, or other parties to facilitate optimal care. 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. The HSD collaborates with RVP to provide trend reporting and analysis to opportunities, identify goals, and develop a plan to meet those goals. Provides input into strategies, operational initiatives and identifies opportunities for performance improvement. In this role, the HSD manages a large team of nurses, specialists and supports the RVP management of the UM physicians.

The person for this role must be able to quickly develop a rapport and trust within the team and manage external relationships in a manner that conveys high credibility and confidence. The highly qualified candidate must be flexible, adaptable, able to manage competing priorities, and be a leader of both people and process.

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 including Utilization Management and/or Case Management

5 or more years of leadership/management experience

Must be willing to travel for provider facing and corporate meetings as conditions require/permit

Knowledgeable in utilization review, medical terminology, appropriate levels of care, treatment, modalities, statues, and healthcare delivery models

Experience working with Medicare populations

Intermediate to advanced computer skills and experience with Microsoft Office specifically Power Point, Word, Excel and Outlook.

Must be skilled in the use of various standard technology platforms and virtual meetings

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

Willing to travel for provider faceting and corporate meetings as conditions require/permit

Preferred Qualifications

Master's Degree

Previous experience within the organization healthcare service operation

Demonstrates a high degree of organizational skill and time management for multiple competing priorities

Demonstrates a high level of sophistication with data and information analytics

Demonstrates an ability to quickly adapt and manage through a changing environment

Demonstrates a high level of emotional intelligence and ability to develop rapport

Demonstrates the ability to manage a large work force and effectively navigate change

If progressed to offer, you will be required to:

Provide proof of full vaccination OR Commit to weekly testing, following all CDC protocols, OR

Provide documentation for a medical or religious exemption consideration.

This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work.

Additional Information

Must be located in the state of Florida or willing to relocate to the Tampa FL metro area.

Scheduled Weekly Hours

40

Company info

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