The IHWA In‑Home Eligibility Lead is responsible for overseeing and managing eligibility strategy, execution, and data integrity for in‑home Quality Focused Visit (QFV) and related IHWA vendor programs. This role ensures accurate member targeting, consistent eligibility logic, and timely file delivery across multiple vendor partners, supporting high‑quality execution, Stars outcomes, and operational scalability.

The Eligibility Lead partners closely with IHWA operations, Stars, analytics, IT, and external vendors to design and maintain eligibility criteria, minimize overlap across in‑home programs, and proactively identify and resolve eligibility risks. This role plays a critical part in translating program and quality requirements into executable eligibility rules, data files, and automated processes.

Operating with a high degree of autonomy, the IHWA In‑Home Eligibility Lead analyzes complex data, exercises sound judgment, and drives continuous improvement in eligibility processes to support program growth, vendor performance, and member experience. The role also supports the transition from manual processes to automated, scalable solutions, ensuring readiness for future growth and evolving business needs.

• Bachelor’s degree in business, healthcare administration, public health, information systems, or a related field; equivalent experience considered
• 5+ years of experience in healthcare operations, program delivery, eligibility management, or performance analytics
• Demonstrated experience managing eligibility criteria and file delivery across multiple vendors or partners
• Strong understanding of in‑home healthcare programs, quality initiatives, or Stars‑related workflows preferred
• Proven ability to work with complex data sets, including eligibility files, member lists, and disposition data
• Experience collaborating cross‑functionally with IT, analytics, operations, and vendor partners
• Strong analytical and problem‑solving skills, with the ability to identify eligibility risks, inconsistencies, or gaps
• Excellent communication skills, including the ability to explain complex eligibility logic to technical and non‑technical stakeholders
• Ability to manage multiple priorities and deadlines in a fast‑paced, high‑visibility environment
• Proficiency with SQL
• Proficiency with data and reporting tools (e.g., Excel, SQL, Power BI, Tableau, or similar)

• Experience supporting Quality Focused Visits (QFV) or similar quality‑driven in‑home programs
• Familiarity with Medicare Advantage, Stars measures, and member eligibility requirements
• Experience designing or managing daily eligibility file processes and automation initiatives
• Background in vendor governance, performance monitoring, or contract support
• Experience defining eligibility logic, prioritization rules, and exclusion criteria to minimize overlap and operational risk
• Knowledge of data governance, data quality controls, and audit readiness
• Experience working with APIs or automated data exchanges with external partners
• Master’s degree in healthcare administration, public health, data analytics, or a related field

Remote-Work-At-Home Requirements

To ensure Work-at-Home 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.

• Satellite, cellular and microwave connection can be used only if approved by leadership.

• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

• Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.