AD Clinical Strategy & Policy Governance

📋 Description

• • The Associate Director, Clinical Strategy & Practice – Policy Governance leads enterprise-level Utilization Management (UM) policy governance, driving strategy to increase clinician capacity, enhance recruitment and retention, and ensure compliance with Medicaid, NCQA, CMS, and state requirements.
• • Day-to-day responsibilities include providing end-to-end leadership for Medicaid UM governance, standardizing UM letter workflows, ensuring policy alignment with regulatory standards, and leading cross-functional initiatives with clinical, compliance, legal, operations, and IT teams to improve quality and reduce regulatory risk.
• • Humana Inc. is a leading U.S. healthcare company dedicated to improving health outcomes for Medicare and Medicaid beneficiaries, families, individuals, and military personnel through integrated insurance and CenterWell healthcare services, with a commitment to equity, inclusion, and whole-person well-being.
• • In this role, you will develop scalable governance models, lead process improvement efforts using data-based insights, advance sustainable workforce strategies, and gain executive-level experience in healthcare policy, compliance, and operational leadership within a national managed care organization.