Health Services Director - Wisconsin

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

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

Additional Information

Scheduled Weekly Hours

40

Company info

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