Associate Director, Health Services Nursing

Humana

Associate Director responsible for care management and utilization management in Health Services Nursing at Humana. Collaborating across teams to optimize performance and improve member outcomes.

Posted 7/26/2026full-timeRemote • South Carolina • 🇺🇸 United StatesSenior💰 $104,000 - $143,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Care Management and Utilization Management, with a strong focus on clinical operations, performance metrics, and regulatory compliance. Proven ability to lead teams, develop policies, and guide members towards optimal wellness.

Highest-signal resume keywords

Registered Nurse (RN) LicenseClinical Leadership ExperienceUtilization ManagementCare Management LeadershipMedicaid-Related Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care ManagementUtilization ManagementPerformance Metrics EvaluationPolicy DevelopmentClinical Operations

Soft Skills

Team LeadershipGuidance and SupervisionInterpersonal Communication

Tools & Technologies

Microsoft OfficePowerPointWordExcelOutlook

Certifications & Qualifications

Active Registered Nurse (RN) License

Industry Keywords

Medicaid Regulatory RequirementsNational Committee for Quality Assurance (NCQA) StandardsInterQual CriteriaMCG CriteriaASAM Criteria

About the role

Key responsibilities & impact

responsible for driving excellence in care management (CM) and utilization management inpatient (UM) clinical operations
oversee the assessment and evaluation of members' needs and requirements to achieve and maintain optimal wellness
guide members/families toward and facilitate interaction with resources appropriate for the care and well-being of members
provide supervision and daily guidance to care management and utilization management team members
monitor and evaluate performance metrics and outcomes to ensure the effectiveness and quality of care management activities
develop and implement departmental policies and procedures in accordance with contract changes and/or updates

Requirements

What you’ll need

An active, unrestricted Registered Nurse (RN) license in the State of South Carolina with no disciplinary actions
Bachelor's degree in nursing (BSN) or a related healthcare field
Three (3) or more years of clinical leadership experience in utilization management
Three (3) or more years of care management leadership experience
Three (3) or more years of Medicaid-related experience
Familiarity with InterQual, MCG, and/or ASAM criteria
Comprehensive knowledge of Microsoft Office applications, including PowerPoint, Word, Excel, and Outlook
Knowledge of Medicaid regulatory requirements and National Committee for Quality Assurance (NCQA) standards

Benefits

Comp & perks

medical, dental and vision benefits
401(k) retirement savings plan
time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
short-term and long-term disability
life insurance
many other opportunities