AD Clinical Strategy & Policy Governance
Humana, Olympia, WA, United States
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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 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.
Key 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.
Required Qualifications
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.
Preferred Qualifications
Experience with UM Committees and Medicaid adverse determination letters.
Process improvement certification (e.g., Lean Six Sigma, PMP).
Additional Information
Workstyle:
Remote
Must be able to work Eastern Time Zone hours.
Travel:
1‑2 times annually for onsite meetings.
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.
$126,300 – $173,700 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.
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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
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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 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.
Key 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.
Required Qualifications
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.
Preferred Qualifications
Experience with UM Committees and Medicaid adverse determination letters.
Process improvement certification (e.g., Lean Six Sigma, PMP).
Additional Information
Workstyle:
Remote
Must be able to work Eastern Time Zone hours.
Travel:
1‑2 times annually for onsite meetings.
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.
$126,300 – $173,700 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.
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.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
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