Become a part of our caring community
 

The Health Services Lead serves as the subject matter expert and operational leader supporting the design, implementation, and sustainability of Utilization Management (UM) clinical programs. This role ensures clinical integrity, regulatory alignment, and consistency across markets while advancing national UM strategy, standardization, and governance priorities.

The Health Services Lead serves as a key partner to Market teams, Strategy Advisors, enterprise shared service partners, operational leaders, and cross-functional teams, ensuring clinical requirements are translated into practical policies, standardized workflows, and scalable processes that support consistent execution.

Role Responsibilities

• Clinical workflow validation and recommendations
• UM input into program design and implementation plans
• Policy and procedure review with documented clinical and operational feedback
• UM clinical decision-making guidance and escalation support
• Documented clinical and/or operational scenarios, decisions, assumptions, and recommendations to reduce ambiguity
• Contributions to training materials, role-specific job aids, and reference resources
• Input into system configuration or technical build requirements for UM workflows
• Implementation readiness assessment, including identification of workflow gaps, risks, dependencies, and training needs
• Policy development and approval to include ESP information requests
• Workflow adoption support and post-implementation feedback gathering
• Post-implementation evaluation of program effectiveness, including clinical workflow adoption and readiness gaps
• Process improvement and standardization recommendations
• Risk, issue, and dependency documentation for clinical, regulatory, operational, or market-specific concerns

Use your skills to make an impact
 

Required Qualifications

• Active Licensed Registered Nurse, RN in your state of residence without disciplinary action OR Licensed Practical Nurse (LPN), Social worker (LCW, LCSW), counselors (LPC, LCPC, LMFT)
• 3+ years managed care in health plan, Medicare/Medicaid experience
• 3+ years utilization management experience
• Experience with policy, process, workflow, proofing and formatting
• Reviews data to identify trends and opportunities for process improvement.
• Proficient in Excel and Word

Additional Information

Workstyle: Remote work at Home

Schedule: Monday through Friday 8:00 AM -5:00 PM Eastern time and may fluctuate during high demand business needs.

Travel: Must be available to travel to various Humana locations, which may include out of state for new business once a month and occasionally for meetings and/or trainings.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

 

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

 

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.

 

$94,900 - $130,500 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 08-06-2026

About us
 

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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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.