Engage members via phone to conduct non-clinical health assessments and identify barriers to care. Assist members in scheduling appointments and accessing health-related resources while documenting information in company systems.
The analyst will deliver proactive, forward-looking cyber threat intelligence to guide Humana's security strategy and operational countermeasures. They are responsible for prioritizing threats, producing intelligence assessments, and collaborating with internal teams to strengthen organizational preparedness.
The Associate Director leads the planning, design, and engineering of operational excellence and application reliability across business-critical platforms. They are responsible for driving SRE principles, managing incident response, and ensuring the resiliency and health of digital, cloud, and vendor-supported services.
The professional collaborates with internal and external partners to develop and produce print materials for Group Medicare employer audiences. They are responsible for coordinating production, managing vendor relationships, and providing operational recommendations based on organizational strategy and CMS guidelines.
The Growth Strategy Principal will lead high-impact strategy projects and manage cross-functional teams to drive growth and profitability for Humana's Medicare and Medicaid businesses. This role involves synthesizing strategic choices into coherent plans, facilitating critical meetings, and driving consensus among executive leadership.
The Utilization Management Nurse coordinates and documents medical services to support value-based care for members. They review clinical information against established guidelines and communicate with providers and members to facilitate appropriate treatment.
The Quality Assurance Professional reviews LTSS contractor documentation and performance to ensure compliance with state and federal regulations. They also conduct audits, analyze operational metrics, and identify improvement opportunities to prevent fraud, waste, and abuse.
The Director of Corporate Strategy will lead enterprise-wide strategic planning and cross-functional projects to drive growth and innovation. They will provide strategic guidance to senior leadership and the Board, managing teams to conduct industry analysis and financial modeling.
The Senior Coding Educator identifies documentation and coding improvement opportunities while providing guidance on risk adjustment methodology to providers. They facilitate training, analyze performance indicators, and develop action plans to ensure accurate clinical documentation and compliance.
The representative reviews Level 1 appeal cases to ensure accuracy, compliance with Medicare requirements, and proper documentation for external review. They also monitor case work to identify trends, manage risks, and support operational metrics.
Design, implement, and maintain secure cloud infrastructure and CI/CD pipelines across Azure and GCP environments. Manage enterprise DevOps platforms including JFrog, Argo CD, and GitHub while ensuring regulatory compliance and software supply chain security.
The Lead Product Manager will oversee the end-to-end product life cycle for clinical initiatives aimed at improving health outcomes for members with chronic conditions. They will collaborate with cross-functional stakeholders to develop operational models, roadmaps, and data-driven strategies to address complex business and clinical challenges.
The role involves conducting field-based sales of Medicare Advantage plans through face-to-face interactions, community events, and in-home visits. You will be responsible for building relationships, educating prospects, and utilizing digital platforms to manage enrollments and documentation.
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 manage member consultations using company-issued technology.
The RN Care Manager provides case management and health monitoring for members within the Family Care Partnership program through home and community visits. They collaborate with an interdisciplinary team to assess member needs, implement care interventions, and ensure quality, cost-effective service delivery.
The Senior Business Intelligence Engineer solves complex business problems by analyzing data from internal and external sources to provide actionable insights. They are responsible for designing data models, developing front-end applications, and influencing the department's technical strategy.
The role involves supporting pharmacists and patients by conducting comprehensive medication reviews and managing prescription drug optimization. You will perform outbound and inbound calls to communicate with members, collect medication history, and provide health awareness education.
The role manages the end-to-end delivery and operational readiness of acquisition and retention campaigns across various health initiatives. It coordinates cross-functional teams to ensure campaigns are compliant, market-ready, and effectively executed across multiple member touchpoints.
The role involves analyzing, integrating, and visualizing complex datasets to support enterprise strategy and continuous improvement. You will also elicit and document business requirements, develop long-term data solutions, and coordinate cross-team collaboration with IT and business stakeholders.
The Care Manager will perform telephonic and face-to-face assessments to evaluate enrollee needs and guide them toward appropriate behavioral health resources. They will collaborate with an interdisciplinary team to create and monitor care plans, ensuring enrollees progress toward optimal wellness.
The Medical Director is responsible for Medicaid care strategy and operations, including making authorization determinations for services and levels of care. They conduct peer-to-peer discussions with external physicians and support regional market priorities through collaborative business relationships.
The professional will utilize behavioral health knowledge to support the coordination, documentation, and communication of medical services and benefit administration determinations. They will interpret criteria and policies to facilitate optimal care while working independently to resolve varied assignments.
The investigator conducts audits and investigations into allegations of fraudulent or abusive healthcare billing practices. They are responsible for assembling evidence, coordinating with law enforcement, and preparing complex investigative reports.
The Consumer Experience Lead manages cross-enterprise projects to resolve root cause issues and improve operational effectiveness. They analyze complex data to identify improvement opportunities and influence decision-making across various business levels.
The Medical Director performs clinical reviews of health claims and determines the authorization of services based on national guidelines and regulatory requirements. They also collaborate with internal and external stakeholders to support regional market priorities and value-based care initiatives.
The investigator conducts complex investigations into allegations of healthcare fraud, waste, and abuse while collaborating with law enforcement and internal legal teams. They are responsible for assembling evidence, performing on-site audits of provider records, and preparing detailed investigative reports.
The Senior Risk Management Professional supports the intake, assessment, and implementation of Medicare and PBM pharmacy regulatory guidance. They partner with stakeholders to ensure accurate implementation, documentation, and compliance with regulatory requirements.
The Lead Actuary is responsible for setting pricing assumptions, submitting bids, and filing premium rates with regulatory agencies. They also provide guidance on product development and analyze market-level financial metrics to ensure segment profitability.
The Lead Enterprise Architect aligns business vision with technology strategy to drive value-driven outcomes and improve member experiences. They provide mentorship to architecture teams and facilitate the adoption of enterprise architecture principles across the organization.
The Senior Compliance Professional performs oversight audits of claims delegates to ensure adherence to state, federal, and Humana standards. They drive corrective actions, manage key relationships, and prepare detailed audit reports for management and stakeholders.
