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The Associate Director, Health Services Nursing is responsible for driving excellence in utilization management (UM) clinical operations through process improvement initiatives, process development, market enablement, targeted process audits, and training facilitation. This role oversees new market implementations, leads inter-rater reliability (IRR) processes, and ensures adherence to relevant policies and regulations. The Associate Director, Health Services Nursing collaborates across clinical and operational teams to advance best practices, support strategic growth, optimize performance and advance best practices in UM.

The Associate Director, Health Services Nursing is responsible for leading the development, optimization, and continuous improvement of UM processes and workflows.

• Oversee new market implementations, ensures compliance with organizational and regulatory policies, and collaborate with clinical and operational teams to drive strategic initiatives.
• Evaluate market readiness and operational requirements, develop strategies to address identified gaps, and support efforts that ensure new and existing markets are fully functional and compliant within utilization management.
• Provide expertise and leadership necessary to assess market needs, develop entry strategies, and coordinate cross-functional efforts.
• Ensure compliance with regulatory requirements, industry best practices, and organizational standards.
• Own and support inter-rater reliability (IRR) processes, promoting consistency in clinical decision-making and ongoing reviewer alignment.
• Conduct targeted process audits to identify improvement opportunities, mitigate risks, and ensure compliance with regulatory requirements, industry best practices, and organizational standards.
• Design and refine UM policies and procedures, direct process improvement projects, support policy development and implementation, and prepare performance reports for senior leadership.
• Facilitate training sessions, workshops, and collaborative meetings to engage stakeholders, promote best practices, and ensure staff proficiency in UM protocols.
• Monitor regulatory changes and industry trends to proactively inform process and policy updates, providing guidance and training to UM staff.
• Drives continuous process improvement initiatives that enhance efficiency, quality, and member experience within UM.

Use your skills to make an impact
 

Required Qualifications

• An active, unrestricted, Registered Nurse (RN) license.
• Five (5) or more years of professional experience working in the health care industry and/or in utilization management/utilization review.
• Two (2) or more years of formal leadership experience.
• Progressive leadership experience hiring, training, and managing associates.
• Highly adept at managing processes from concept to completion ensuring on-time, on-budget, and on-target results.
• Proficiency in analyzing and interpreting data trends.
• Experience in reviewing and analyzing financial, quality, and utilization data and analytics.
• Project management experience. 
• Comprehensive knowledge of all Microsoft Office applications, specifically Excel, and PowerPoint.
• Ability to use a variety of electronic information applications/software programs including electronic medical records.
• Ability to identify, structure and solve business problems.
• Excellent interpersonal, organizational, written, and oral communication and presentation skills.

Preferred Qualifications

• BSN, bachelor’s in business, health services or a related field.
• Medicare and Managed care experience working for similar health plans.

Additional Information

• Workstyle: This is a remote position.
• Travel: This role may require up to 10% travel for onsite meetings, which could include locations outside your state of residence.
• Typical Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
• Direct Reports: Up to 10 associates.

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$104,000 - $143,000 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 06-29-2026

About us
 

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.