AD Clinical Strategy & Policy Governance

Humana

1d • Remote

About The Position

The Associate Director, Clinical Strategy and Practice develops and implements strategy. This strategy drives targeted initiatives aimed at increasing enterprise clinician capacity, enhancing clinician recruitment, development, and retention, and supporting clinician licensure compliance and continuing education. Reporting to the Director, Clinical Strategy & Practice, you will use data-based insights to direct process improvement efforts within the clinical community. You will also relate decisions to resolving complex technical and operational problems within department(s) and could lead multiple managers or specialized professional associates. The Associate Director, Clinical Strategy & Practice – Policy Governance provides enterprise leadership and oversight for Utilization Management (UM) policy governance. This oversight also includes UM Committee (UMC) functions and UM letters, including Medicaid adverse determination letters. You will ensure, compliant, and scalable application of UM standards across programs. The Associate Director leads governance‑driven strategy, process improvement, and restructuring efforts to address inefficiencies, reduce regulatory risk, improve quality and, and support a sustainable workforce model. This role partners with clinical, compliance, legal, operations, and process improvement leaders to ensure governance decisions are operationalized across markets.

Requirements

• Bachelor’s degree in healthcare administration, public health, business administration, or a related field.
• 3+ years direct management experience
• 5+ years of experience in healthcare operations, utilization management, policy governance, or related areas within a managed care or health plan environment.
• Strong knowledge of Medicaid, NCQA, CMS, and state regulatory requirements relevant to utilization management.
• Demonstrated experience leading cross-functional projects or governance initiatives in a healthcare setting.

Nice To Haves

• UM Committees and Medicaid adverse determination letters.
• Process improvement certification (e.g., Lean Six Sigma, PMP).

Responsibilities

• Provide end-to-end leadership for Medicaid UM governance, including UMC and UM policy design, implementation, and sustainability.
• Ensure UM policies and governance decisions align with NCQA, CMS, and state requirements and are applied consistently across markets.
• Establish standardized UM governance processes to support compliance, scalability, and audit readiness.
• Provide governance oversight for Medicaid UM letters, including adverse determinations, to ensure quality and compliance.
• Standardize and optimize UM letter workflows, roles, handoffs, and quality controls to support efficiency and workforce sustainability.
• Lead and partner across clinical strategy, UM operations, compliance, legal, quality, and IT to advance centralized UM strategy and sustainable operating models.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees