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CarePlus Health Plans Inc. is seeking an Associate Director of Clinical Strategy and Policy Governance to develop and implement strategies aimed at enhancing clinician recruitment, retention, and compliance within Medicaid utilization management. The role requires strong leadership and experience in healthcare operations, particularly in regulatory compliance and process improvement.
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Job Summary
Develops and implements strategy aimed at increasing enterprise clinician capacity, enhancing clinician recruitment, development, and retention, and supporting clinician licensure compliance and continuing education.
Provides enterprise leadership and oversight for Utilization Management (UM) policy governance, including UM Committee (UMC) functions and UM letters.
Humana offers competitive benefits that support whole-person well-being, including medical, dental and vision benefits, 401(k) retirement savings plan, and time off.
Matching Summary
Match Score: 75
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CarePlus Health Plans Inc. is seeking an Associate Director of Clinical Strategy and Policy Governance to develop and implement strategies aimed at enhancing clinician recruitment, retention, and compliance within Medicaid utilization management. The role requires strong leadership and experience in healthcare operations, particularly in regulatory compliance and process improvement.
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Salary
Base: $126,300 - $173,700 per year; Bonus/Equity: eligible for a bonus incentive plan; Benefits: medical, dental and vision benefits, 401(k) retirement savings plan, time off
Skills & Requirements
Must-have
Utilization Management policy governance
UM Committee functions
Medicaid adverse determination letters
NCQA, CMS, and state requirements
Standardized UM governance processes
Cross-functional project leadership
Nice-to-have
Process improvement certification
Lean Six Sigma
PMP
Key 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
Strong knowledge of Medicaid, NCQA, CMS, and state regulatory requirements
Demonstrated experience leading cross-functional projects or governance initiatives