The Care Manager provides telephonic support to Medicare members by assessing their physical, behavioral, and psychosocial needs to develop individualized care plans. They collaborate with interdisciplinary teams to coordinate care, remove barriers to health, and prevent avoidable hospitalizations.
The analyst supports value-based provider relationships by analyzing financial patterns, trends, and fee structures to achieve organizational goals. They collaborate with internal departments to ensure contract accuracy and compliance with government regulations.
The Field Service Coordinator assesses member needs and develops person-centered care plans to facilitate access to long-term services and support. They collaborate with care teams and community partners to ensure holistic service delivery and improve health outcomes for members.
The Transition Coordinator evaluates member needs and facilitates access to appropriate resources to ensure continuity of care during transitions between health programs and settings. They conduct in-person and telephonic meetings with members, families, and healthcare professionals to develop and implement specific care plans.
The Lead Security Architect designs secure, enterprise-scale solutions and aligns security infrastructure with business priorities. They lead security assessments, threat modeling, and vulnerability analysis while influencing stakeholders to mitigate risks within the SDLC.
The Senior Analytics Consultant leads complex analytical initiatives and serves as a strategic partner to business leaders to drive business outcomes. They translate ambiguous business questions into analytical approaches and deliver actionable insights through data-driven recommendations.
The Senior Insider Threat Engineer is responsible for configuring, tuning, and optimizing enterprise insider threat technologies like Microsoft Purview and Proofpoint. This role collaborates with cross-functional teams to detect, investigate, and mitigate insider risks while ensuring alignment with regulatory frameworks.
The Care Coach conducts telephonic outreach to members with chronic conditions to assess needs and develop individualized care plans. They coordinate clinical and community resources while monitoring health outcomes and resolving barriers to care.
The RN Care Manager will assess member health needs to develop comprehensive care plans and provide ongoing education on disease processes and lifestyle modifications. They will also coordinate with primary care providers and perform record reviews to ensure compliance and quality of care.
Design, develop, and maintain scalable omnichannel APIs while enhancing security, resiliency, and performance across enterprise platforms. Collaborate with cross-functional teams to deliver AI-assisted engineering solutions and provide Tier 3 support for critical production incidents.
You will lead the development and optimization of real-time member journeys using Adobe Experience Platform and Adobe Journey Optimizer. This involves configuring campaigns, collaborating with data teams to refine audience segments, and monitoring performance to ensure business outcomes.
The Compliance Coordinator reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations. They also collect and analyze data to assess operational metrics and make independent decisions regarding work methods.
The Associate Vice President will define the multi-year vision, strategy, and roadmap for Humana’s enterprise digital platform portfolio. They will lead cross-functional teams to drive platform adoption, ensure value realization, and establish governance models across the organization.
The Associate Vice President will own the product strategy and roadmap for conversational channels, including IVR, AI-enabled engagement, and CRM tools. They will lead cross-functional teams to deliver integrated, AI-enabled experiences that improve member outcomes and advocate effectiveness.
Engage members via phone to conduct health assessments, identify care barriers, and connect them with appropriate resources. Manage inbound and outbound calls in an auto-dialer environment while maintaining accurate documentation of member information.
The Technical Product Lead will define and own the product vision, strategy, and roadmap while serving as the primary link between business, architecture, and development teams. They are responsible for managing product backlogs, facilitating Agile ceremonies, and ensuring technology solutions meet security and scalability requirements.
The Strategy Advancement Advisor will lead strategic planning efforts, define growth agendas, and develop business cases to support OneHome's transformation. This role involves managing strategic portfolios, facilitating executive-level communications, and collaborating across Humana to drive actionable outcomes.
The AVP will set the strategic direction for clinical programs and products to improve quality, reduce medical costs, and enhance member engagement for Medicare Advantage populations. This role involves leading a team of 20 associates to build, pilot, and scale home-based care models across a matrixed organization.
The Clinical Business Lead provides operational and team lead support for programs serving dual-eligible members, managing daily workflows and staffing. This role monitors productivity and quality, identifies performance barriers, and partners with leadership to ensure operational goals are met.
The Enterprise Transformation Lead will drive the evolution of Humana's sales experience by developing roadmaps and identifying opportunities to improve member and agent interactions. This role involves leading cross-functional teams to implement solutions, measure outcomes, and ensure seamless process efficiency across the organization.
The role is responsible for leading the strategy, execution, and continuous improvement of acquisition and retention dialer campaigns. It involves partnering with cross-functional teams to translate business goals into actionable outreach strategies that maximize contact rates and conversion performance.
The Clinical Pharmacy Lead will develop and operationalize formulary strategies and utilization management policies to improve health outcomes and reduce costs. They will also conduct drug trend analysis and provide clinical expertise to senior leadership to inform functional strategies.
The Senior Professional coordinates Green Glove engagement activities, develops content and communications, and analyzes performance data to drive program impact. They also partner across teams to manage deliverables, track progress, and ensure initiatives are executed consistently and professionally.
The intern will contribute to real-world evidence studies, including study conceptualization, protocol development, and statistical analysis. They will also participate in synthesizing and presenting research findings to Humana stakeholders.
The Referrals Coordinator processes medical referrals and authorizations by performing data entry and assigning appropriate provider and coding information. They act as a point of contact for military and civilian providers to ensure accurate documentation and adherence to quality standards.
The Sales Support Representative provides administrative and operational support to the Medicare sales team to assist with member onboarding and retention. Responsibilities include processing sales invoices, drafting documents, maintaining member records, and communicating with internal and external stakeholders.
The consultant will deconstruct complex business challenges and perform targeted research to develop and implement growth strategies, particularly within Medicare Advantage. They will collaborate with senior leadership and cross-functional teams to deliver high-impact strategy projects and actionable recommendations.
The Growth Strategy Principal will lead high-impact strategy projects, deconstruct complex business challenges, and provide actionable recommendations to senior leadership. They will also facilitate cross-functional collaboration to drive growth and profitability across Humana's Medicare and Medicaid businesses.
The Associate Director oversees sales compliance activities to ensure adherence to federal, state, and organizational regulations. They collaborate with leadership to identify risks, implement corrective actions, and maintain robust compliance policies.
The professional manages claims operations, including customer contact, investigation, and the settlement of claims for and against the company. They work with insurance companies, providers, and members to research and resolve pending claims while adhering to organizational strategy.
The Director leads Group Medicare account management performance, focusing on client retention, renewal readiness, and strategic value delivery. They coordinate cross-functional teams to achieve operational outcomes while managing complex client portfolios and driving continuous service improvements.
The Care Manager assesses and evaluates member needs to facilitate appropriate resources and maintain optimal wellness. They employ various strategies to manage physical and psycho-social health issues while monitoring patient progress toward desired outcomes.
The Quality Improvement Professional analyzes business processes to develop quantifiable improvements and conducts audits to ensure compliance with CMS and state regulations. They collaborate with staff to remediate audit findings and support organizational quality initiatives through data-driven research and reporting.
The Senior Informaticist will analyze operational data using AI process mining tools to generate actionable insights and drive continuous improvement. They will design and maintain intuitive dashboards in Power BI to communicate complex findings to leadership and delivery teams.
The professional will focus on clinical quality improvement by engaging providers to facilitate education, HEDIS outcomes, and member care. They will also communicate quality initiatives and assist providers in reducing preventable events.
The Behavioral Health Medical Director provides clinical leadership for Medicaid utilization management and makes defensible medical-necessity determinations. Responsibilities include conducting peer-to-peer consultations, managing appeals, and collaborating with internal and external partners to ensure regulatory compliance.
The Care Coordinator will conduct comprehensive health risk assessments and proactively outreach to newly enrolled Medicaid members to identify and address healthcare needs. They will coordinate services, monitor care plans, and facilitate access to community resources to ensure members receive optimal care in the least restrictive settings.
The Senior Software Engineer designs, codes, and maintains Appian-based applications to meet business requirements in a HIPAA-regulated environment. They also manage platform configuration, develop system integrations, and promote engineering best practices.
The Senior Data Engineer designs, builds, and maintains scalable data pipelines and workflows to transform structured and unstructured data into actionable insights. This role involves collaborating with cross-functional teams to integrate data solutions while ensuring high standards of reliability, performance, and security.
The Clinical Pharmacist will manage pharmacotherapy for high-risk patients with chronic conditions and collaborate with a multi-disciplinary team to optimize patient care. Responsibilities include conducting medication reconciliation, providing patient education, and supporting quality measures like CMS Stars and HEDIS.
The Program Delivery Lead drives product lifecycle and strategy for behavioral health portfolios, focusing on enhancing provider performance and network access. They manage cross-functional teams, lead value-based initiatives, and maintain relationships with large provider groups to improve member outcomes.
The Care Manager will assess and evaluate the physical, behavioral, and psychosocial needs of enrollees to create and monitor holistic care plans. They will collaborate with an interdisciplinary team to facilitate access to resources and ensure optimal wellness outcomes for members.
The Lead Product Manager will own the product lifecycle for consent and preference management capabilities, driving execution, adoption, and continuous improvement. They will collaborate with cross-functional teams to ensure data compliance and integration across digital, marketing, and service ecosystems.
The Principal Actuary analyzes and forecasts financial, economic, and operational data to support strategic decision-making and business intelligence. They also ensure data integrity, provide strategic guidance to leadership, and collaborate across teams to improve analytic consistency and insight generation.
The specialist conducts quality assurance audits of medical records and ICD-9/10 diagnosis codes while traveling to provider offices to retrieve and validate documentation. They are responsible for uploading verified records to a centralized repository while ensuring strict adherence to HIPAA and federal regulations.
The Lead will manage the integrated program delivery and vendor performance for a key Medicare Advantage supplemental benefit, ensuring operational stability and high-quality member experiences. They will serve as the primary operational integrator, coordinating cross-functional teams and providing data-driven insights to support executive decision-making.
The Market Development Advisor leads and coordinates complex operational and strategic initiatives to support market goals and drive cross-functional alignment. This role identifies and resolves operational challenges, manages stakeholder relationships, and ensures the successful execution of high-visibility projects.
The Director of Program Delivery oversees the execution of strategic programs, ensuring alignment with business goals and operational outcomes. They provide leadership in project management, governance, risk mitigation, and cross-functional communication to ensure successful program delivery.
The role involves ensuring data integrity by analyzing complex data challenges and uncovering trends using tools like Python, SQL, and Power BI. You will partner with stakeholders to resolve data issues, perform root cause analysis, and advocate for innovation in data management practices.
The professional coordinates and documents medical services while interpreting clinical criteria to determine appropriate treatment for members. They facilitate communication between providers and members to ensure optimal care delivery within organizational strategy.
The Senior Scrum Master facilitates agile teams to iteratively deliver value while acting as a servant leader to foster accountability and continuous improvement. They guide teams in Scrum and SAFe practices, remove impediments, and collaborate with stakeholders to ensure high-quality product delivery.
The Associate Director leads Data Center Engineering and Deployment teams to design, deploy, and support strategic infrastructure initiatives. This role focuses on establishing engineering standards, automation practices, and technical roadmaps to support scalable and resilient business growth.
The Lead Technical Product Manager will lead the development of next-generation digital pharmacy experiences and reusable technical capabilities. They will partner with Engineering and Architecture to define product strategy, manage the backlog, and ensure successful delivery of scalable digital solutions.
Design, implement, and maintain secure cloud infrastructure and CI/CD platforms across Azure and GCP. Manage enterprise DevOps tools including JFrog, Argo CD, and Kubernetes while ensuring regulatory compliance and software supply chain security.
The Lead Product Manager defines the product vision, strategy, and roadmap for enterprise pharmacy modernization initiatives. They lead cross-functional teams to translate business needs into scalable, automated, and resilient technology solutions.
You will build and operate AI-driven offensive tooling and agentic workflows to enhance red-team and penetration testing operations. Additionally, you will conduct adversarial assessments of internal AI systems and collaborate with defensive teams to validate security countermeasures.
The Principal leads enterprise-wide strategy for provider network transitions and disruption events to ensure organizational readiness and operational alignment. They partner with cross-functional leaders to assess risks, develop mitigation strategies, and improve member and provider experiences during network changes.
Engage members via phone to conduct non-clinical health assessments and identify barriers to care. Assist members in scheduling appointments and accessing health resources while documenting information in an auto-dialer environment.
The Lead Application Architect designs and develops enterprise-level IT architecture solutions, focusing on integration, interoperability, and cloud platform strategies. They provide technical leadership, mentor engineering teams, and ensure all solutions align with regulatory requirements and business objectives.
The Project Manager will lead end-to-end delivery of cross-functional projects supporting clinical operations, regulatory compliance, and business transformation. They are responsible for defining project scope, managing risks, facilitating governance, and ensuring operational readiness across various business stakeholders.
The Director, HR Business Partner leads the people agenda by aligning talent strategy with business priorities to drive organizational, leadership, and culture outcomes. They serve as a trusted advisor to senior leaders, orchestrating integrated HR support to ensure the business meets its contract commitments and growth objectives.
The Consumer Engagement Lead manages end-to-end implementation planning, readiness, and adoption activities across operations and partner organizations. This role serves as the central coordinator to ensure all people, processes, and resources are aligned for successful project launches and operational performance.
The Data and Reporting Professional generates ad hoc reports and datasets using system tools, database queries, and scripts. They integrate data from multiple sources to maintain information dashboards and report formats while supporting organizational strategy.
The Associate Actuary analyzes and forecasts financial, economic, and market data to support strategic business decisions and intelligence. They are responsible for building and maintaining Net Present Valuation models in Databricks while ensuring data integrity and collaborating with cross-functional partners.
The Accounting Lead performs general accounting activities including ledger maintenance, financial statement preparation, and reconciliation. They also provide financial support through forecasting, budgeting, and advising executives on functional strategies.
The Senior Application Architect designs and develops IT architecture solutions that align with enterprise standards and business needs. They are responsible for technical planning, creating architecture artifacts, and influencing department strategy for complex project components.
The Lead will design and build scalable capabilities for the supplemental benefits portfolio while managing high-priority, cross-functional initiatives. They are responsible for translating regulatory requirements into operational plans, improving vendor performance governance, and driving continuous process improvements.
The RN Care Manager assesses member health and safety needs to develop comprehensive care plans and provides ongoing education on disease processes and lifestyle modifications. They coordinate care with primary and acute providers while maintaining accurate documentation and conducting regular member visits.
The Senior Process Improvement Professional analyzes and optimizes business processes related to provider data quality and claims resolution to improve operational efficiency. They collaborate cross-functionally to identify gaps, develop performance metrics, and implement solutions that align with government business requirements.
The Pre-Authorization Nurse reviews prior authorization requests for medical necessity and appropriate care settings using clinical judgment. They also educate providers on utilization management processes and maintain clinical information in medical management systems.
The Care Manager conducts telephonic assessments to identify clinical, behavioral, and social needs while developing and implementing individualized care plans. They coordinate care, facilitate access to resources, and collaborate with interdisciplinary teams to improve member health outcomes.
The Director will lead the development and oversight of sales compliance programs to ensure adherence to federal and state regulations. They will manage compliance teams, conduct risk assessments, and serve as a primary liaison between the organization, carrier partners, and regulatory agencies.
The Associate Director develops business processes to ensure the successful submission and reconciliation of encounter data to Medicaid and Medicare. They are responsible for ensuring data integrity, meeting compliance standards, and resolving complex technical and operational problems.
The IT Procurement Lead develops and executes category strategies while managing end-to-end sourcing initiatives for complex technology solutions. They serve as a trusted advisor to senior leadership, negotiating agreements and managing strategic supplier relationships to ensure alignment with business and risk requirements.
The manager leads teams of nurses and behavioral health professionals to oversee the assessment and evaluation of members' behavioral health needs. They are responsible for making tactical decisions, resolving barriers to care, and ensuring alignment with organizational strategy.
The Senior Accreditation & Licensing Professional leads accreditation, licensing, and regulatory compliance initiatives to ensure adherence to standards and organizational policies. This role manages complex assignments, drives continuous quality improvement, and partners with cross-functional teams to mitigate risks and support business strategy.
The Senior Project Manager oversees the end-to-end execution of complex insurance initiatives, ensuring projects are delivered on time and within budget. They are responsible for managing resources, coordinating cross-functional teams, and driving strategic alignment across the organization.
The RN Care Manager assesses member health and safety needs to develop comprehensive care plans while coordinating with primary and acute care providers. They also provide education on disease processes and lifestyle modifications while maintaining accurate documentation within contract timeframes.
Lead the enterprise event strategy and portfolio, translating business priorities into executive meetings, conferences, customer events, and other high-impact experiences from concept through evaluation. Manage and develop a team of event planners, oversee budgets and external partners, align cross-functional stakeholders, and establish governance, risk management, and performance measurement practices.
Assess members’ health, safety, strengths, and preferences; develop and maintain Member Care Plans; and coordinate services with a Field Care Nurse and community providers. Conduct required in-person and phone contacts, arrange non-medical supports, evaluate risks, promote cost-effective service delivery, and maintain accurate case documentation.
Assess members' health and safety needs, develop comprehensive care plans, and conduct regular health assessments and monthly phone contacts. Coordinate with healthcare providers, educate members on health and lifestyle topics, document care within required timeframes, and travel for in-person member visits.
Receive, sort, distribute, review, and process Medicaid member correspondence, including enrollment forms, eligibility documents, and claims-related communications. Track mail status, protect confidential member information, and coordinate with other teams to resolve processing issues and meet Medicaid requirements.
Assess members’ healthcare and support needs through in-person and telephone evaluations, develop and monitor personalized care plans, and coordinate services and community resources. Visit members in homes and care facilities, address barriers and gaps in care, support grievances and appeals, and collaborate with providers, payer sources, and interdisciplinary teams.
Develop and conduct Medicaid compliance audits and monitoring, interpret regulatory and contract requirements, and advise business partners on controls and corrective actions. Present findings, oversee timely remediation, support external audits, and coordinate compliance communications with regulators.
The Care Coordinator assesses member needs, develops personalized care plans, and coordinates services to ensure optimal health outcomes. This role involves frequent travel to visit Medicaid members in their homes and care facilities to resolve barriers and monitor progress.
The Director will lead enterprise-wide quality validation strategies, cross-platform integration assurance, and end-to-end business workflow certification. They are responsible for driving AI-enabled quality practices, managing release readiness, and fostering a culture of technical excellence within the engineering team.
The Cloud Solutions Engineer 2 is responsible for designing, implementing, and maintaining cloud architecture and the Genesys Cloud CX platform. This role collaborates with stakeholders to deliver scalable contact center solutions while ensuring platform performance and security compliance.
The Field Care Manager assesses member needs and coordinates care plans to ensure optimal wellness through home and community-based visits. They serve as the primary point of contact for the Interdisciplinary Care Team to facilitate access to medical, social, and educational services.
The Regional CMO provides executive leadership to drive clinical excellence, performance, and culture within a value-based care framework. They partner with the Regional Market President to lead clinical teams, improve patient outcomes, and manage regional operations.
You will design, develop, and deploy scalable full-stack applications while actively shaping product roadmaps and requirements. The role involves building accessible user interfaces, implementing robust microservices, and maintaining AI-accelerated development tooling.
The Security Architect II supports the Product Security program by identifying, assessing, and reducing security risks across enterprise applications. This role collaborates with engineering and architecture teams to provide risk-based remediation guidance and support secure software development practices.
The Chief Medical Officer, Utilization Management will lead the clinical strategy and oversee the integration of medical and nursing staff across Medicaid and Medicare programs. This executive role is responsible for driving operational efficiency, improving Star Ratings, and ensuring evidence-based clinical practices throughout the organization.
The Field Care Manager Nurse assesses and evaluates member needs to facilitate optimal wellness by guiding families toward appropriate resources. They manage physical and psycho-social health issues while monitoring patient progress through regular evaluations and care plan development.
The Associate Vice President leads the enterprise framework for model and AI governance, ensuring all AI deployments are safe, ethical, and compliant with risk appetite. This executive provides second-line oversight and partners with cross-functional leadership to manage risks associated with advanced analytics and emerging AI technologies.
The Transition Coordinator evaluates member needs to establish care plans and facilitates transitions between care settings and programs. They collaborate with healthcare professionals and families to ensure continuity of care and prevent unnecessary custodial placements.
The Regional Senior TRICARE Community Liaison manages provider relations, ensures network adequacy, and provides expert guidance on TRICARE policies within an assigned territory. They also lead the resolution of inquiries and complaints while supporting value-based care initiatives and stakeholder outreach.
The Enterprise Transformation Lead plans and implements process improvement initiatives such as Lean or Six Sigma across divisional teams. They lead cross-functional projects from concept to closure while identifying operational gaps and driving mitigation strategies.
The Senior Process Improvement Professional analyzes and measures existing business processes to develop sustainable, quantifiable improvements that enhance cost, quality, and member experience. They lead cross-functional initiatives and influence leadership using data-driven insights to achieve annual cost savings targets.
The Growth Strategy Manager will lead high-impact strategy projects, focusing on Medicare enrollment growth and investment optimization. They will perform complex research and analysis to provide actionable recommendations to senior leadership.
Assess members’ behavioral health needs and guide them and their families to appropriate care and community resources. Develop or support care plans, address barriers to effective care, and monitor progress toward desired outcomes through ongoing assessments and evaluations.
The AVP will lead enterprise strategy for contingent workforce, outsourcing, and consulting services to drive measurable business outcomes and operating leverage. They will serve as a senior commercial advisor to business leaders, shaping operating models and workforce decisions while managing complex supplier relationships.
The Director of Product Management leads all phases of the product life cycle, from inception to marketplace introduction, to meet customer needs and business outcomes. They also implement strategic plans, drive cross-functional alignment, and monitor product efficacy to ensure continuous improvement.
The Senior Portfolio Enablement Lead shapes and enables portfolio operations, Agile Release Train design, and ways of working across the organization. This role acts as a trusted advisor to senior executives to translate transformation strategy into scalable execution and improved value delivery.
The Consumer Experience Lead manages strategic and operational initiatives to improve business performance and resolve member abrasion points. They are responsible for analyzing complex issues to identify root causes and building relationships to influence decision-making across the organization.
The Care Management Support Assistant provides non-clinical administrative support to assess and evaluate member needs. They facilitate interaction with wellness resources and perform moderately complex operational tasks under minimal direction.
The Medical Director reviews complex outpatient cases and preauthorization requests to make coverage determinations based on clinical guidelines and CMS policies. They also collaborate with internal and external partners to support care management, quality outcomes, and value-based care initiatives.
The Value-Based Programs Lead will design and operationalize specialty Medicaid value-based payment models to improve provider performance and total cost of care. This role involves analyzing financial and utilization data while collaborating with cross-functional teams to scale innovative payment strategies.
The Field Service Coordinator assesses member needs and develops care plans to promote optimal wellness and health outcomes. They collaborate with care teams and community partners to connect members with necessary long-term services and support.
The Lead Product Manager will own the end-to-end product lifecycle for medication experience and pharmacy solutions, from strategy and discovery to delivery and optimization. They will partner with cross-functional teams to drive digital engagement and improve member outcomes through data-driven decision-making.
The Lead Solutions Architect will own the architectural vision for complex, multi-system initiatives and provide leadership for CenterWell Home Health platforms. They will act as a connective force between business strategy, engineering execution, and enterprise standards while governing solution designs.
The Senior Product Owner defines the product vision and roadmap while prioritizing the product backlog for an Agile delivery team. They serve as the primary contact for information and decision-making, ensuring the product is built within budget and deadlines.
The intern will support the Medicaid Clinical Services team by managing client services, claims processing, and call center operations. Responsibilities include verifying authorizations, scheduling visits, and assisting members with financial assistance for utilities and housing.
The Case Manager provides care management services including psychosocial assessments, service plan development, and ongoing monitoring for adults with disabilities and the frail elderly. They collaborate with an interdisciplinary team to coordinate medical, social, and rehabilitation services to help members achieve their desired outcomes.
The Program Delivery Lead manages the annual Medicare Advantage bid planning, development, and submission process by coordinating across multiple functional teams. This role ensures governance, stakeholder engagement, and timely execution of complex enterprise initiatives while driving continuous process improvements.
The Inbound Contacts Representative addresses incoming inquiries via phone, digital, or written channels and conducts outbound calling campaigns to assist members. They are responsible for resolving complex benefit questions, documenting interactions, and escalating unresolved grievances.
The pharmacist performs medical necessity and comprehensive medication reviews for pre-authorization requests. They also analyze medication care plans and intervene with providers to ensure cost-effective, high-quality patient outcomes.
The Senior Hospital Contracting Strategist initiates, negotiates, and executes complex provider contracts and agreements for a health insurance organization. They partner with internal departments like Finance and Legal to ensure contracts are financially sound and operationally executable.
The Senior Software Engineer will design, build, and maintain SSIS packages and C#/.NET API integrations to facilitate secure data exchange and system connectivity. They will collaborate with technical teams to optimize SQL processes, ensure security compliance, and support deployment workflows.
The Program Integrity Researcher reviews, documents, and investigates allegations of fraud, waste, and abuse by maintaining accurate database records. This role also conducts follow-up outreach to members and providers while organizing medical records and claims data to support investigations.
The Senior Product Owner conveys the product vision and roadmap to an Agile delivery team by defining user stories and prioritizing the product backlog. They serve as the primary contact for information and decision-making while ensuring the product is built within budget and by the deadline.
The Senior Product Owner conveys the product vision and roadmap to an Agile delivery team by defining user stories and prioritizing the product backlog. They serve as the primary contact for information and decision-making while ensuring the product is built within budget and by the deadline.
The Associate Actuarial Director is responsible for setting pricing assumptions, submitting Medicare Advantage bids, and ensuring regulatory compliance for premium rates. They also manage a team of associates, provide financial guidance to leadership, and develop strategies for profitable membership growth.
The RN Field Care Manager assesses and evaluates member needs to develop individualized care plans that promote optimal wellness and recovery. They facilitate communication across the care team and coordinate services for physical health and social determinants of health.
The Medical Director performs clinical reviews to determine the appropriateness of requested services and levels of care based on national guidelines and CMS policies. They also collaborate with internal teams to ensure compliance and provide medical interpretation for billing and grievance processes.
The Chief Medical Officer will oversee regional clinical strategy, utilization management, and quality improvement initiatives to ensure fiscal responsibility and operational excellence. They will also serve as a clinical liaison with healthcare providers and facilities to maintain relationships and drive performance metrics.
The RN Care Manager assesses member health and safety needs to develop comprehensive care plans and coordinates with acute and primary care providers. They also provide member education on disease processes and lifestyle modifications while maintaining accurate documentation in compliance with contract requirements.
The RN Care Manager will assess member health and safety needs to develop comprehensive care plans and coordinate with primary care providers. They will also provide ongoing education to members regarding disease processes, lifestyle modifications, and health risks while maintaining accurate documentation.
The Functional Screener will conduct in-home, face-to-face interviews to assess member needs and eligibility using the State Department of Health Services screening tool. They will also manage appointment scheduling, maintain accurate documentation, and participate in quality assurance activities.
The Case Manager will assess member health and safety needs to develop comprehensive care plans and coordinate support services. They will conduct regular face-to-face and phone assessments to ensure members receive appropriate, cost-effective care in the least restrictive environment.
The RN Field Care Manager assesses and evaluates member needs to develop individualized care plans that promote wellness and recovery. They facilitate communication across the care team and coordinate services to ensure quality, cost-effective health outcomes.
The RN Care Manager assesses member health and safety needs to develop comprehensive care plans and coordinates with primary care providers. They provide ongoing education on disease processes and lifestyle modifications while maintaining accurate documentation within contract timeframes.
The Case Manager will assess member health and safety needs to develop comprehensive care plans and coordinate services for frail elders and adults with disabilities. They are responsible for conducting regular face-to-face assessments, maintaining accurate documentation, and ensuring cost-effective service delivery.
The Senior RX Clinical Programs Pharmacist oversees medication therapy, comprehensive medication reviews, and prescription drug optimization for patients. They drive health awareness through patient education and targeted quarterly campaigns while influencing departmental strategy.
The Field Care Manager serves as the primary point of contact for members, providing integrated behavioral health care management and coordinating services to improve health outcomes. They lead interdisciplinary care teams, facilitate care planning, and conduct face-to-face assessments within the community to address health-related social needs.
The Portfolio Enablement Lead shapes and advances Humana's portfolio operating model and Agile Release Train design across multiple portfolios. This role acts as a trusted advisor to executive leadership to drive alignment, flow, and measurable business outcomes through enterprise transformation.
The Float Case Manager will assess member health and safety needs to develop comprehensive care plans and coordinate services across the SW region of Wisconsin. This role involves conducting regular in-person and phone assessments while maintaining accurate documentation and ensuring cost-effective service delivery.
The AVP will lead the end-to-end lifecycle of clinical programs and products, from strategy and design to implementation and scaling. They will drive cross-functional collaboration across the enterprise to improve health outcomes, member experience, and financial performance.
The representative will support pharmacists and patients by managing medication therapy programs and conducting comprehensive medication reviews. They will also handle inbound and outbound calls to confirm patient medication adherence and provide health education.
The Director leads Humana's state advocacy and government engagement strategy across Illinois and a regional group of states. This role advances policy priorities, manages relationships with key stakeholders, and coordinates legislative and regulatory activities to support business growth.
The Associate Actuary provides actuarial support for the Illinois Medicaid market, including capitation rate reviews and financial forecasting. They also advise executives on functional strategies and perform complex business analytics under the supervision of an FSA Actuary.
The Lead Cloud Architect will provide strategic leadership and engineering oversight for enterprise NoSQL database platforms across cloud environments. This role involves designing, implementing, and modernizing database solutions while ensuring they are secure, scalable, and aligned with enterprise standards.
The RN Care Manager assesses member health and safety needs to develop comprehensive care plans and coordinates with acute and primary care providers. They also provide ongoing education to members and maintain accurate documentation in compliance with contract requirements.
The Care Coach evaluates member needs and coordinates services to facilitate optimal wellness and resolve barriers to care. They monitor patient progress through assessments, data analysis, and active care planning to ensure desired health outcomes.
The professional will conduct annual quality reviews, perform medical record abstractions for Coordination of Care studies, and analyze data to implement corrective actions. They will also support organizational strategy by managing project goals and facilitating care for members.
The Principal Software Engineer will develop AI-powered software solutions, intelligent applications, and reusable frameworks to transform enterprise quality engineering. They will provide technical leadership, mentor engineering teams, and integrate advanced AI capabilities into production-ready enterprise platforms.
The IT integration leader provides strategic guidance for M&A, divestitures, and joint ventures, managing end-to-end IT integration plans and due diligence. This role involves partnering with corporate development and senior leadership to ensure technology alignment, risk mitigation, and synergy realization.
The RN Field Care Manager assesses member needs, develops care plans, and coordinates services to ensure optimal health outcomes in home and community settings. They serve as the primary contact for the Interdisciplinary Care Team and conduct comprehensive clinical assessments to ensure regulatory compliance.
The Group Sales Representative develops and maintains brokerage relationships to drive sales of ancillary group insurance products. They are responsible for executing strategic sales plans, conducting presentations, and collaborating with internal teams to meet production objectives.
You will architect goal-setting and decomposition mechanisms for autonomous agents operating in dynamic environments. Additionally, you will develop evaluation frameworks to ensure agent alignment with human intent and operational reliability.
The Senior Care Coordinator provides mentorship, coaching, and field support to team members while ensuring compliance and quality in case management plans. They conduct home visits for Medicaid members and coordinate care across interdisciplinary teams to ensure patients meet their health goals.
The assistant will engage members via phone to conduct non-clinical health assessments and identify barriers to care. They will also assist members in scheduling appointments and accessing health-related benefits while documenting all interactions in an auto-dialer system.
The field agent is responsible for selling Medicare insurance products to prospective clients within the assigned territory. They will manage client relationships and ensure compliance with all insurance regulations.
The Behavioral Health Medical Director is responsible for developing behavioral health care strategy, operations, and new delivery models while ensuring quality of care and financial goals. They use their medical expertise to make authorization determinations for services and collaborate with external providers to support regional market priorities.
The field agent is responsible for selling Medicare insurance products to clients within Jefferson County, Missouri. They will manage client relationships and provide professional guidance on insurance coverage options.
You will build trust and educate individuals on Medicare Advantage plans while conducting grassroots marketing and in-home visits. Additionally, you will drive self-generated sales and meet performance goals to expand the company's presence in the local community.
The Medicare Sales Field Agent will educate individuals on Medicare Advantage plans and build trust through face-to-face interactions and community events. They are responsible for driving self-generated sales and meeting performance goals while expanding the company's market presence.
The agent will build trust and educate individuals on Medicare Advantage plans through face-to-face interactions and community events. They are responsible for driving self-generated sales and meeting performance goals within their assigned territory.
The Medicare Sales Field Agent will build trust and educate individuals on Medicare Advantage plans through grassroots marketing and in-home visits. They are responsible for driving self-generated sales and meeting performance goals within their assigned territory.
The Medical Director provides clinical determinations and medical interpretations to ensure healthcare services align with national guidelines, CMS requirements, and Humana policies. They collaborate with cross-functional teams to support departmental objectives, quality outcomes, and appropriate utilization management.
Conduct home and facility visits to assess Medicaid members' needs and develop personalized care plans. Coordinate services and monitor patient progress to ensure optimal well-being and access to community resources.
The Medicare Sales Field Agent will build trust and educate individuals on Medicare Advantage plans through face-to-face interactions and community events. They are responsible for driving self-generated sales, meeting performance goals, and expanding the company's presence within their assigned local territory.
The agent will build trust by educating individuals on Humana's Medicare Advantage plans and related offerings through face-to-face connections, community events, and in-home visits. Responsibilities also include driving self-generated sales, meeting performance goals, and expanding market presence by becoming a valued community resource.
As a Bilingual Medicare Sales Field Agent, you will educate individuals on Humana’s Medicare Advantage plans and create meaningful connections through community engagement. You will also drive self-generated sales and expand Humana’s presence in the market.
As a Medicare Sales Field Agent, you will build trust and educate individuals on Humana’s Medicare Advantage plans while creating meaningful connections through community engagement. You will drive self-generated sales and expand Humana’s presence in the market.
As a Bilingual Medicare Sales Field Agent, you will build trust and educate individuals on Humana’s Medicare Advantage plans while creating meaningful connections through community engagement. You will also drive self-generated sales and expand Humana’s presence in the market.
The Senior Stars Improvement, Clinical Professional is responsible for the development, implementation, and management oversight of the company's Medicare/Medicaid Stars Program. This role involves monitoring provider performance in key performance indicators related to preventive care and chronic conditions.
The Quality Assurance, Clinical Professional 2 develops and implements programs to maintain quality standards and conducts quality audits to improve care management services. This role collaborates with various partners on quality, process, and performance improvement initiatives.
The Director of Investment Governance & Portfolio Management will oversee the IT organization’s investment governance processes, ensuring alignment with strategic objectives. This includes managing the intake, prioritization, and execution of investment initiatives while collaborating with cross-functional stakeholders.
The Associate Director of Care Management will lead teams responsible for care management, overseeing the assessment and evaluation of members' needs. They will guide the development and implementation of care management programs while ensuring effective communication with stakeholders.
The Sales Support Professional 1 provides timely and effective sales administrative support to assist with the acquisition or retention of customers. This role involves supporting the Sales team throughout the sales cycle and collaborating with internal stakeholders.
The Pharmacy Contracting Professional 2 ensures all published materials support the contracting process and may perform analysis regarding pharmacy claims and purchasing data. They draft communications for stakeholder review and coordinate with various departments to publish communications.
The Informatics Lead is responsible for leading the development and refinement of EOC volume forecasting models for Humana Clinical Pharmacy Review activities. This position supports operational resource planning and integrates business initiatives while ensuring forecast accuracy.
The Senior Pharmacy Contracting Professional conducts all aspects of pharmaceutical contracting and pricing, including development, implementation, and maintenance. They oversee relationships with Humana pharmacy partners and support pharmacies throughout the contracting process.
As a Medicare Sales Field Agent, you will build trust and educate individuals on Humana’s Medicare Advantage plans while creating meaningful connections through community events and in-home visits. Your role will also involve driving self-generated sales and expanding Humana’s market presence.
As a Medicare Sales Field Agent, you will build trust and educate individuals on Humana’s Medicare Advantage plans while creating meaningful connections through community engagement. You will drive self-generated sales and expand Humana’s presence in the market.
The Senior Quality Assurance, Clinical Professional consults and collaborates with clinicians to ensure high accountability of compliance and quality. They conduct case audits, assist with audit preparation, and support quality improvement projects.
