Associate Director, Health Services Nursing

The Associate Director, Health Services Nursing is responsible for driving excellence in care management (CM) and utilization management inpatient (UM) clinical operations through process improvement initiatives, process development, market enablement, targeted process audits, and training facilitation. 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. Leads all efforts in finding and executing creative ways to remove friction from the system for both members and provider partners.

Oversees assessment and evaluation of members' needs, coordinates with Clinical Leadership team to ensure utilization reviews comply with Medicaid contract terms, provides supervision and daily guidance to care management and utilization management team members, ensures adoption of appropriate medical necessity criteria, monitors performance metrics, develops departmental policies and procedures, maintains compliance with NCQA, DHHS, and CMS guidelines, participates in audit preparation, and leads multiple managers or highly specialized professional associates.