Managing Director jobs at BlueCross BlueShield of South Carolina - 24 jobs
AVP, Underwriting Major Group
Bluecross Blueshield of South Carolina 4.6
Managing director job at BlueCross BlueShield of South Carolina
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Position Purpose:
As the AVP of Underwriting Major Group, you will be responsible for the selection of acceptable health underwriting risks and insuring that prospective and renewal business is maintained at adequate and competitive rate levels. The AVP of Underwriting Major Group directs all activities associated with underwriting and policy processing for the company. You will also be responsible for the strategic and tactical management of the underwriting staff as well as maximizing premium production while minimizing financial risk, and underwriting of new/renewal contracts. Decisions made in this position have the opportunity to produce income and/or prevent loss.
Description
Location: This position is full-time (40-hours/week) Monday-Friday working ONSITE at our 4101 Percival Road, Columbia, SC location.
Logistic: BlueCross BlueShield of South Carolina
What You'll Do:
Manages the Large Group Underwriting department.
Oversees the fully insured and self-insured underwriting activities of Large Group products. This includes risk selection, determination of benefits, policy issuance rates and price, provision of service, reinsurance, and policy processing.
Manages and oversees Stop Loss Underwriting department. Interfaces with external stop loss carriers and MGU's. This includes risk selection, determination of benefits, policy issuance rates and price, provision of service, and policy processing.
Manages the Dental Underwriting department. Oversees the fully insured and self-insured underwriting activities of Individual products. This includes risk selection, determination of benefits, policy issuance rates and price, provision of service, reinsurance, and policy processing.
Develops and updates underwriting rules and regulations applicable to regional underwriting, ensuring compliance with appropriate state and federal regulations.
Develops and maintains external agency relationship strategies to foster long term relationships, consistent growth, and knowledge of competitive underwriting practices.
Works closely with internal functional areas (Finance, Claims, Membership, Marketing, Premium Audit) to achieve company goals.
To Qualify for This Position, You'll Need the Following:
Required Education: Bachelor's degree
Required Experience:
10+ years Underwriting experience.
3 years Management experience or equivalent military experience in grade E5 or above (may be concurrent).
Required Skills and Abilities:
Knowledge of insurers/competitive practices preferably in the following: underwriting of large group, small group, individual classes, dental, ASO, and stop loss.
Knowledge of the operations of the corporation and its various subsidiaries. Understanding of advanced mathematics and rating methodologies.
Ability to understand medical records information and their impact on underwriting.
Knowledge of South Carolina as well as federal insurance laws and regulations.
Excellent communication (verbal and written), presentation, and interpersonal skills.
Ability to exercise good judgment with a capacity of communicating with a diverse range of individuals.
Proven ability to organize and manage multiple priorities.
Strong analytical, strategic planning, and decision-making skills.
Ability to adapt to ever changing business environment/priorities.
Proficiency in word processing and spreadsheet software.
We Prefer That You Have the Following:
10+ Years-Underwriting experience to include Large Group, Small Group, Individual, and Self Insured.
Exceptional understanding of risk and health delivery systems.
Experience working national accounts.
Microsoft Office, with proficiency in Excel.
Excellent communication, presentation, decision-making and analytical skills.
Demonstrated problem-solving skills, understanding of key health care financial and operational metrics.
Strong financial acumen.
Strong grasp on all aspects of the funding arrangements to include pharmacy and stop loss.
Understanding of the Blue system and Blue Card.
Our comprehensive benefits package includes the following:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
Subsidized health plans, dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more
What We Can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
Management will be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
Some states have required notifications. Here's more information.
$99k-127k yearly est. Auto-Apply 60d+ ago
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Remote Associate Director, Finance Data Management
Humana Inc. 4.8
Washington, DC jobs
A leading health service provider in Washington is seeking an experienced Associate Director of Finance Data Management to support configuration control, data management, and deficiency reporting. This role requires strong collaboration across teams to establish data architecture and adherence to compliance standards. The ideal candidate should have a Bachelor's degree and extensive operational experience within Finance, coupled with a solid understanding of data manipulation and ERP systems. This position also includes a competitive salary and bonus incentives.
#J-18808-Ljbffr
$111k-141k yearly est. 3d ago
Director, Workforce Management
Centene 4.5
Remote
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose:
The Director, Workforce Management serves as a business leader who will be responsible for building, managing, and owning workforce management strategy, process, and execution. Will focus on tactical and strategic plans, capacity planning, quality, efficiency standards, and tool development to meet short-term and long-term business objectives.
Drives accountability for the workforce management function and supports the development of long-term growth plans.
Ensures business operations provides high levels of service by leading the short- and long-term staffing models and monitoring daily activities.
Develops staffing model strategies based on trends and forecasted results to create the most effective and efficient support models for business operations.
Influences adherence to established policies and procedures within workforce management.
Adheres to department budget and allocates resources according to project(s) and schedule; reviews actual and budgeted comparisons and ensures expenses reflect effective and efficient utilization of company resources.
Ensures strong partnerships between workforce management, training and other lines of business.
Act as a key driver for change to support growth initiatives and continued business improvement and transformation.
Use data, technology and innovation to drive continuous improvement to identify, assess and resolve issues across business operations.
Supports daily inventory management and SLA performance of the organization.
Drives cross functional improvements in processing times and prevention of aging work.
Performs other duties as assigned.
Complies with all policies and standards.
Education/Experience:
A Bachelor's Degree in a related field or equivalent experience required. A Master's Degree in business administration or analytical field preferred. 7+ years of professional level experience. Experience to include strategy development, identifying and implementing process improvements, presenting to senior management, and analytical background. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. Demonstrated experience in workforce management across call center and/or back-office environments highly preferred.
Pay Range: $148,000.00 - $274,200.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
$148k-274.2k yearly Auto-Apply 3d ago
Director, Privacy Officer & Managing Counsel
Blue Cross Nc 4.8
Remote
The Director of Managing Counsel will oversee the delivery of legal services and advice for the Company, acting as the main attorney for Blue Cross NC's Privacy Program. This role manages both attorneys and non-attorneys and oversees Blue Cross NC's Privacy Program related to safeguarding employee, customer and corporate information pursuant to legal, regulatory and contractual requirements and standards that govern Privacy, and reports directly to the Vice President of the Legal Department & Deputy General Counsel. The Managing Counsel brings expertise in several areas of law essential to both the Company and its subsidiaries, works closely with Company Officers and senior executives, and leads the team within the Legal Department.
What You'll Do
Directs the efforts of the legal staff and related support personnel while utilizing legal expertise to ensure the Company and its subsidiaries are in compliance with various laws and regulations that govern Privacy.
Serves as the Privacy Officer for the Company, responsible for overseeing the development, implementation, maintenance, and enforcement of privacy policies and procedures in accordance with state and federal laws and regulations. Serves as primary point of contact for privacy-related matters, including regulatory inquiries, customer concerns, and internal escalations.
Develops strategy to accomplish objectives and ensures the Company and its subsidiaries maintain a solid legal foundation upon which to conduct business.
Advises and counsels Company Officers, senior management, and the Board of Directors on privacy laws that arise in the Company's business operations; researches and prepares legal memoranda and opinions applying technical legal knowledge to varying business situations and personnel issues; assists Company management with risk identification and management.
Assists the Company with business transactions and the development of new products, services, and business relationships.
Confers and negotiates with attorneys and management in other companies.
Attends high-level conferences involving BCBSNC management and management in other companies or senior government positions.
Writes legal opinions or otherwise provides legal advice that require extensive research of statutes, regulations, or court decisions in complex areas of law.
Leads practice area team (e.g., corporate, health care plans).
Supervises direct reports including performance management, coaching, conflict resolution, motivating and engaging. Manages growth and development of personnel, with career development, performance management and succession planning. Assigns projects to team members, coaches and mentors team members.
Participates in development of, interprets, and improves Company policies. Assists the Company with implementing existing and new programs, policies, and procedures.
Researches, interprets, and advises on statutory and case law, administrative rules, and regulations. Monitors legislative and regulatory proposals, evaluates such proposals, and assists Company management with formulating the Company's position of these matters.
Performs management duties include hiring, training, coaching, counseling and evaluating performance of direct reports.
Makes decisions regarding retention of outside counsel and manages substantial budget for external legal services.
Performs other duties as assigned.
What You Bring
JD from an accredited law school
10 years of professional legal experience
5 years of leadership experience
In lieu of degree, 12+ years of experience in related field
Licensed to practice law in North Carolina or must obtain License within 1 year of employment.
Bonus Points
Certified in Healthcare Privacy and Security (CHPS) or Certified Information Privacy Professional (CIPP) highly preferred.
HIPAA and other similar federal and state privacy, security and data protection regulations highly preferred
What You'll Get
The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community.
Work-life balance, flexibility, and the autonomy to do great work.
Medical, dental, and vision coverage along with numerous health and wellness programs.
Parental leave and support plus adoption and surrogacy assistance.
Career development programs and tuition reimbursement for continued education.
401k match including an annual company contribution
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
$210,268.00 - $336,430.00
Skills
Administrative Law, Business Contracts, Commercial Contract Management, Contract Management, Contract Negotiations, Law, Legal Administration, Legal Analysis, Legal Compliance, Legal Consulting, Legal Practices, Legal Research, Legal Services, Legal Support, Negotiation, People Management, Privacy Compliance, Privacy Laws, Procurement, Statutory Interpretation, Vendor Contracts
$110k-161k yearly est. Auto-Apply 17d ago
Vice President, Medicare Market - PA, DE & NJ
Centene 4.5
Remote
Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.
Responsible for the growth and performance of assigned mid/high complexity and revenue Medicare markets within a region, driving enterprise goals in membership, earnings, quality, network performance, provider experience, and compliance. Develop and execute market-specific strategies, foster cross-functional collaboration, develop strong internal and external partnerships with key stakeholders and drive operational excellence. A hands-on executive who balances strategic vision with disciplined execution, while leading and organizing a multi-disciplinary, cross functional and cross line of business team to achieve results. Results oriented, strong communicator, culture builder, organized and disciplined. Represents the Medicare business with authenticity, accountability, and results orientation.
Responsible for the P&L management of assigned markets; including management of clinical, financial, and key operational performance.
Develop market-specific strategic operating plans with KPIs, milestones, and governance processes that supports organizational goals.
Lead expansion and performance of value-based care initiatives.
Provides leadership direction and vision to innovate and improve the performance of the business.
Monitor and analyze the changing landscape and recommend strategies and programs to proactively address the changing needs of the markets (Provider & Members).
Drive quality initiatives aligned with STAR outcomes and continuous improvement.
Build collaborative and effective partnerships with internal and external stakeholders, becoming a trusted Medicare thought leader, respond to evolving stakeholder/market needs, and elevate brand awareness in local market communities.
Identify the appropriate strategic approach to drive business growth and differentiate the product in the assigned markets.
Works collaboratively with product, shared services and market leaders to ensure that Medicare enterprise-wide networks, quality and risk, clinical, operational, financial and leadership expectations are met.
Provide effective leadership to direct and matrixed teams, fostering a culture of collaboration, innovation, and accountability.
Performs other duties as assigned.
Complies with all policies and standards.
Education/Experience: Bachelor's Degree in Business Administration, Healthcare Administration, other related field or equivalent experience required. Equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. Over 10 years of leadership experience in cross-functional initiatives and more than 5 years in marketing, sales, and/or product development, with a proven track record of identifying and driving growth-enabling strategies required. Proven history of identifying growth-enabling initiatives and opportunities and have business development experience. Demonstrated success in business development through forging long-term strategic alliances and partnerships that have significantly increased revenue,
Markets: PA, DE and NJ.
Pay Range: $227,700.00 - $431,400.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
**Resp & Qualifications** **Candidates must live in the MD/DC/VA surrounding areas in order to travel frequently into the offices and client meetings.** **PURPOSE:** Are you ready to lead a dynamic team and drive strategic growth in the commercial market segment? As the Director of Commercial Accounts, you will provide visionary leadership to the 51-99 commercial Account Consultants, ensuring maximum customer retention and ancillary growth. This pivotal role involves overseeing, managing, and directing the team to boost sales volume for our commercial employers, while also contributing to the achievement of our corporate goals.
**ESSENTIAL FUNCTIONS:**
+ **Team Leadership:** Inspire and manage a talented team of Account Consultants, ensuring top-notch performance and professional development.
+ **Retention & Growth:** Achieve retention, renewal, and financial goals for medical and specialty products within the 51-99 commercial segment.
+ **Relationship Building** : Foster positive relationships with key market constituents, brokers/consultants, government officials, and vendor partners across the service area.
+ **Collaboration** : Partner effectively with internal teams and subject matter experts to meet client needs and maintain a positive organizational reputation.
**QUALIFICATIONS:**
**Education:** Bachelor's Degree in Business, Marketing, Sales, or a related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
**Licenses/Certifications:**
+ Current health and life license for Maryland, DC, and Virginia.
**Experience:**
+ 11 years of sales experience with a focus on strategic, consultative selling.
+ 3 years of management experience.
+ Proficiency in Salesforce
**Preferred Qualifications:**
+ Industry Knowledge: Expertise in fully insured and self-funded accounts.
**Knowledge, Skills and Abilities (KSAs):**
+ Strong leadership and training capabilities for professional sales personnel.
+ Extensive knowledge of underwriting principles, group health/life insurance financial mechanisms, healthcare delivery systems, and health insurance products.
+ Exceptional facilitation and leadership skills, with the ability to communicate complex issues effectively to both executive and peer audiences.
+ Ability to build productive relationships with internal and external stakeholders.
+ Adaptability to work in a fast-paced environment with changing priorities and deadlines.
**Salary Range:** $136,000 - $229,500 (Salaries are based on education, experience & internal equity) Sales Incentive Targets are separate.
**Travel Requirements:** Frequent travel required (approximately 50%).
**Salary Range Disclaimer**
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
**Department**
Renewal 100-999 MD
**Equal Employment Opportunity**
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
**Where To Apply**
Please visit our website to apply: *************************
**Federal Disc/Physical Demand**
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
**PHYSICAL DEMANDS:**
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
**Sponsorship in US**
Must be eligible to work in the U.S. without Sponsorship
\#LI-KL1
REQNUMBER: 21373
**Resp & Qualifications** **Candidates must live in the MD/DC/VA surrounding areas in order to travel frequently into the offices and client meetings.** **PURPOSE:** Are you ready to lead a dynamic team and drive strategic growth in the commercial market segment? As the Director of Commercial Accounts, you will provide visionary leadership to the 51-99 commercial Account Consultants, ensuring maximum customer retention and ancillary growth. This pivotal role involves overseeing, managing, and directing the team to boost sales volume for our commercial employers, while also contributing to the achievement of our corporate goals.
**ESSENTIAL FUNCTIONS:**
+ **Team Leadership:** Inspire and manage a talented team of Account Consultants, ensuring top-notch performance and professional development.
+ **Retention & Growth:** Achieve retention, renewal, and financial goals for medical and specialty products within the 51-99 commercial segment.
+ **Relationship Building** : Foster positive relationships with key market constituents, brokers/consultants, government officials, and vendor partners across the service area.
+ **Collaboration** : Partner effectively with internal teams and subject matter experts to meet client needs and maintain a positive organizational reputation.
**QUALIFICATIONS:**
**Education:** Bachelor's Degree in Business, Marketing, Sales, or a related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
**Licenses/Certifications:**
+ Current health and life license for Maryland, DC, and Virginia.
**Experience:**
+ 11 years of sales experience with a focus on strategic, consultative selling.
+ 3 years of management experience.
+ Proficiency in Salesforce
**Preferred Qualifications:**
+ Industry Knowledge: Expertise in fully insured and self-funded accounts.
**Knowledge, Skills and Abilities (KSAs):**
+ Strong leadership and training capabilities for professional sales personnel.
+ Extensive knowledge of underwriting principles, group health/life insurance financial mechanisms, healthcare delivery systems, and health insurance products.
+ Exceptional facilitation and leadership skills, with the ability to communicate complex issues effectively to both executive and peer audiences.
+ Ability to build productive relationships with internal and external stakeholders.
+ Adaptability to work in a fast-paced environment with changing priorities and deadlines.
**Salary Range:** $136,000 - $229,500 (Salaries are based on education, experience & internal equity) Sales Incentive Targets are separate.
**Travel Requirements:** Frequent travel required (approximately 50%).
**Salary Range Disclaimer**
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
**Department**
Renewal 100-999 MD
**Equal Employment Opportunity**
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
**Where To Apply**
Please visit our website to apply: *************************
**Federal Disc/Physical Demand**
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
**PHYSICAL DEMANDS:**
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
**Sponsorship in US**
Must be eligible to work in the U.S. without Sponsorship
\#LI-KL1
REQNUMBER: 21373
$136k-229.5k yearly 60d+ ago
AVP, Special Investigations Unit
Blue Cross Nc 4.8
Remote
The AVP Special Investigations Unit (SIU) is responsible for overseeing and managing fraud, waste, and abuse (FWA) detection, investigation, and prevention efforts to safeguard the organization's assets and reduce healthcare costs. This requires demonstrating vision in positioning the SIU with the right skill sets, cutting edge analytics tools, and robust processes to identify FWA schemes and direct investigations to resolve issues effectively and efficiently.
The AVP will develop strategies to create and maintain an organization that has the flexibility, knowledge, business acumen, and capacity to successfully address the dynamic space of FWA. This role involves leading a matrixed team of investigators, analysts, and clinical/coding subject matter experts, working closely with internal and external stakeholders and ensuring compliance with regulatory requirements. The AVP SIU also will coordinate closely within the Payment Integrity team to flag (i.e., pend, review) suspect providers and develop pre-and post-payment approaches to the challenges of FWA. The AVP SIU requires externally facing credibility and leadership to collaborate with government regulators and the Blue Cross Blue Shield Association in connection with FWA investigation and reporting.
What You'll Do
Leadership:
Lead and mentor a team of fraud investigators, analysts, and other staff, providing guidance and support in fraud detection, prevention, and recovery efforts.
Establish team goals, monitor performance, and ensure alignment with organizational objectives.
Collaborate internally with other departments to create and maintain a seamless claims payment integrity program. Serve as liaison with other key departments (Medical Management, Network Management, Data Analytics, Claims & Enrollment Operations) to develop, monitor, and update respective roles, responsibilities, and strategies related to claims payment integrity activities.
Fraud Detection and Prevention:
Work closely with analytics teams to contribute to the development of fraud detection strategies using data analytics, machine learning, and other advanced techniques to identify patterns of fraudulent behavior.
Conduct risk assessments to identify vulnerabilities in the organization's processes and implement measures to mitigate these risks. Design and manage proactive fraud prevention programs to minimize exposure to fraudulent activities.
Investigation Management:
Oversee the management of the SIU's intake and investigative procedures and coordinate with Payment Integrity's prepayment analysts including workflow, productivity, accuracy, timeliness, and interaction with SIU and other Blue Cross NC staff members across the organization
Ensure timely and accurate reporting of investigation findings and coordinate with legal, healthcare, and data teams to take appropriate action.
Collaborate with law enforcement agencies, regulatory bodies, and external partners during investigations.
Prepare comprehensive reports summarizing investigation outcomes, risk assessments, and fraud trends.
Liaison with Blue Cross NC Legal department on all SIU/Legal interactions including communications with provider attorneys and determinations in the pursuit of criminal and civil actions.
Compliance and Regulatory Adherence:
Ensure all fraud investigation and prevention activities comply with state, federal, and industry regulations.
Stay informed about changes in laws, regulations, and industry practices related to healthcare fraud.
Assist in preparing documentation for audits, compliance reviews, and regulatory inquiries.
As a critical component of the organization's Compliance Program, support law enforcement in the prosecution of unlawful activity directed against corporate and customer assets. Establish and maintain working relationships with governmental law enforcement agencies.
Lead the development and delivery of educational awareness and training programs for the organization as part of the annual Code of Conduct training.
Skills:
Strong leadership and team management ability
Excellent communication and presentation skills.
Ability to work cross-functionally with various teams and external partners.
What You Bring:
Minimum 7+ years of experience in healthcare fraud detection, investigation, or auditing
Bachelor's degree preferred in healthcare administration, finance, criminal justice, or related field/specialized training/relevant professional qualification.
In-depth knowledge of healthcare systems claims processing, coding/reimbursement, and regulatory requirements related to healthcare fraud.
Minimum 5+ years in a leadership role.
Bonus Points
(preferred qualifications)
:
Relevant certifications (e.g., Certified Fraud Examiner (CFE), accredited healthcare fraud investigator (AHFI)
What You'll Get:
The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community
Work-life balance, flexibility, and the autonomy to do great work
Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution
Learn more
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
*Based on annual corporate goal achievement and individual performance.
$191,153.00 - $305,845.00
Skills
$104k-138k yearly est. Auto-Apply 16d ago
Vice President, Population Health & Clinical Operations
Centene 4.5
Remote
Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.
In partnership with the CMO, serve as a key stakeholder, decision maker, and catalyst, for all market level population health identification, strategy, evaluation, and monitoring to achieve the Quadruple Aim and drive Centene's Population Health mission at the market level.
Provide strategic leadership for population health internally, as well as with providers, community organizations, advocacy groups, and applicable legislature.
Understand the local healthcare landscape to look for key drivers & opportunities for innovative models targeting the Quadruple Aim.
Understand the unique community health needs and the attributes of the populations served to drive development of programs and service.
Uses analytics to identify key insights about the populations served and drive the development of the interventions to target unique populations.
Oversees performance of all UM functions (prior authorization, concurrent review) for the market per the defined partnership agreement; co-leads agenda planning and annual performance goal setting, unique to market needs
Orchestrates all elements of the population health strategy for the business
Drives MLR initiatives locally through strong partnership and routine with Finance
Partner with the Special Investigations Unit (SIU) to proactively identify patterns of potential fraud, waste, and abuse (FWA) through clinical, claims, and utilization data insights, ensuring timely escalation and coordinated mitigation strategies. Additionally, NHHF will integrate SIU‑driven findings into Population Health & UM operational workflows, informing policy updates, provider education, and process improvements to prevent recurrence of FWA and enhance overall compliance and accountability.
Partners with MDs to translate the needs of the members into intentional clinical program design that delivers successful health outcomes
Liaises with state regulators for clinical programs; proactively reviews and evaluates the utility, performance and ROI of clinical programs and acts as lead/champion to drive awareness and advocacy where needed
Develops comprehensive position papers-supported by clear rationale, data analysis, and documented recommendations-to advocate for program enhancements and strategic changes with internal and external stakeholders.
Coordinates quality initiatives (audits, star ratings, contract reviews, etc.) and activate enterprise and local policies
Informs and executes against contracts (including provider contracts) - driving outcomes captured in contract and operationalizing locally
Contributing member of enterprise and local committees
Serves as an integral member of the executive leadership team, charged with delivering clinical solutions to evolving business needs
Executes on standards and customizing per local requirements while partnering with the COEs to drive continuous improvement through governance and performance monitoring.
Education/Experience:
Bachelor's Degree with 5+ years of relevant experience required.
Master's Degree preferred.
Current state RN license preferred.
research, health policy, information technology or other relevant field. Must have at least five years of progressively responsible professional experience in population health, service coordination, ambulatory care, community health, case or care management, or coordinating care across multiple settings and with multiple providers. Proven leadership in a large, matrixed organization with 3-5 years of experience working with state or federal regulators
Pay Range: $171,900.00 - $326,900.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
$171.9k-326.9k yearly Auto-Apply 8d ago
Vice President, Operations, IHPA
Centene 4.5
Remote
Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.
This is a unique executive leadership opportunity for a hands-on operator with enterprise vision.
This role serves as the Chief Executive Officer of the Illinois Health Practice Alliance (IHPA) - a Behavioral Health Independent Practice Association and joint venture between Centene Corporation and Provider Co, and is responsible for day-to-day and long-term strategic leadership related to the performance of IHPA's statewide clinically integrated network. While titled at the VP level, this role carries full CEO accountability for a focused, high-impact organization.The role provides strategic, operational, and financial leadership to ensure IHPA's objectives align with broader business priorities while advancing value-based care, provider performance, and improved health outcomes for a diverse member population.Position Purpose: Plan and direct all aspects of the company's operational policies, objectives, and initiatives.
Oversee the development of policies and procedures for operational processes to ensure optimization and compliance with established standards and regulations.
Oversee the negotiation and administration of value based contracts to ensure a strong provider network.
Influence and drive network provider performance.
Ensure IHPA clients access to quality of care and adherence to regulatory requirements.
Represent the organization in its relationships with all stakeholders, including health care providers, government agencies, trade associations, health plans, and similar groups.
Deliver leadership and oversight to IHPA staff and contracted vendors.
Develop a sound short-and long-range plan for the organization.
Ensure the adequacy and soundness of the organization's financial structure and review projections of working capital requirements.
Promote enrollment growth by supporting marketing event planning and execution.
Develop and manage network provider relationships.
Education/Experience:
Bachelor's Degree in Business Administration, Finance, Accountancy or a related field required.
Master's Degree preferred.
9+ years of operations, management, or administration in the healthcare or insurance industry required.
Extensive experience in contracting, contract acquisition, operations management, and strategic planning and development.
IPA experience preferred.
Experience in an integrated delivery system and value-based contracting preferred.
Understands the healthcare field from the provider and health plan perspectives, preferably in multiple states and knowledge of the Illinois market.
Pay Range: $168,500.00 - $320,500.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
$168.5k-320.5k yearly Auto-Apply 32d ago
Vice President, Clinical Operations & System Integration
Centene 4.5
Remote
Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.
Leads the strategy and execution of technology solutions to support clinical operations, including but not limited to systems requirement gathering, monitoring and improvements. Oversees the implementation, integration, and ongoing support of clinical systems, as well as ensuring that technology effectively enables clinical staff to deliver high-quality care. Oversees and executes vision and roadmap in collaboration with clinical and technology leaders to drive enterprise-wide clinical technology initiatives and improvements.
Partners with senior leaders to ensure successful product launch, execution, and support for technology solutions.
Leads complex projects and technical innovation activities in collaboration with cross functional leaders in a matrixed environment.
Leads the SME team who provides consultation and direct testing services for all technology initiatives and implementations.
Partners with stakeholders to analyze system needs for all business operations functions, assist with system requirements, influences the design of integrated solutions, and develops integration strategies.
Implements integration solutions within the operations space, ensure thorough testing to guarantee functionality and performance, and oversees deployment.
Identifies and resolves issues related to system integration and provide technical support to end-users.
Documents integration processes, workflows, and system configurations, and provides training to relevant personnel.
Continuously monitors the performance of integrated systems, identifies areas for improvement, and optimizes system performance and reliability.
In essence, the Operations and Systems Integration role is crucial for ensuring that different systems within an organization work together efficiently and effectively, supporting overall business objectives.
Performs other duties as assigned.
Complies with all policies and standards.
Education/Experience:
Bachelor's Degree required or equivalent experience required
7+ years Strong understanding of system architecture, integration technologies, and relevant programming languages required
6+ years Ability to analyze complex technical issues, troubleshoot problems, and develop effective solutions required.
Excellent verbal and written communication skills to effectively collaborate with teams, stakeholders, and end-users required.
Ability to manage integration projects, prioritize tasks, and meet deadlines required
Adaptability to changing technologies and business needs required or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
Pay Range: $223,200.00 - $422,900.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
$127k-164k yearly est. Auto-Apply 17d ago
Regional VP Provider Contracting (Central Region)
Humana 4.8
Remote
Become a part of our caring community and help us put health first Humana is a Fortune 50 market leader in integrated healthcare delivery. As a company whose primary focus is on the well-being of its members, Humana is dedicated to shifting perceptions of the health insurance industry. We believe our role goes beyond that of an insurer to that of a well-being partner. Through product and service offerings anchored in a whole person view of human well-being, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.
Against that backdrop, Humana is seeking an accomplished healthcare leader for the position of Regional Vice President, Provider Contracting. The Regional Vice President will foster the development of strategic provider relationships for all product lines in the Central Region, encompassing KS, MO, IA, NE, IL, WI, MN, ND and SD. This position will develop provider networks that help advance Humana's strategy and goals toward improving the health of the communities we serve. The Regional Vice President will also provide executive leadership to Provider Contracting, Provider Education and Provider Engagement in support of Humana's Group, Medicare, and Medicaid lines of business.
This position reports to the Central Region President and will need to reside within the Region. 20% travel within the region can be expected
Key Responsibilities
Strategic Partner with all segments (Medicare, Group and Medicaid) accountable for developing and maintaining strategic network relationships with regional providers. Ensure adequate coverage of primary care, specialty and ancillary services for Humana to meet both regulatory and sales support need.
Align strategy and priority between different segments/functions and be the defined point of contact for escalated provider engagements and issues.
Lead the transition of targeted membership and providers to engagement agreements.
Work with potential joint ventures and other innovative partnership opportunities.
Develop and lead efforts re: continuous improvement for unit cost strategy.
Ensure access to care for members, network adequacy and gap closure.
Participate with Medicare and Medicaid trend initiatives with key providers and partners.
Executive leadership of Provider Performance and Analytics functions, supporting Humana's value-based contracts and trend bender initiatives.
Collaborate with internal partners to ensure best in class credentialing, contract load and directory accuracy
Incorporate provider feedback and practice perspective into strategy planning, development and operations; enhance the provider experience with Humana.
Align regional and corporate goals and drive these goals into the provider practice leveraging clinical resources.
Provide leadership to regional provider engagement, contracting, and operations teams.
Ensure regional operations are in alignment with the company's strategic objectives.
Leverage talent and resources and champion a collaborative and integrated work environment. Lead initiatives to enhance productivity, develop talent, and change leadership.
Use your skills to make an impact
Required Qualifications:
Bachelor's degree/Master's preferred
7 plus years leadership experience in the healthcare industry
5 plus years leading the end-to-end contract negotiation process through closure for all types of providers (physicians, hospitals, post-acute care facilities) and delegated specialty services.
Comprehensive knowledge of health plan finance and the compensation arrangements between health plans and providers
Knowledge of risk arrangements and ability to influence these arrangements.
Solid track record of hiring and developing talent and preparing associates for roles of broader and greater responsibility.
The ability to identify health service expenses and implement cost control mechanisms within contracts.
Experience identifying and recruiting providers to ensure network alignment with planned sales process execution, orienting providers and managing relationships, and driving improvement in provider satisfaction via education, communication and streamlining claims resolution.
Recognition as a thought leader in the area of healthcare trend mitigation.
Ability to effectively navigate and manage through a matrixed organizational environment in a large (Fortune 250) company.
Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with audiences and positive representation of Humana in external forums
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.
$203,400 - $279,800 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
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.
$203.4k-279.8k yearly Auto-Apply 11d ago
Senior Director, Value Based Performance Management
Centene 4.5
Remote
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.
***Highly preferred that candidate resides in the state of Florida in either, Tampa, Orlando, Miami, or surrounding areas.***
Position Purpose: Creates and implements Network Transformation initiatives across a market. Develops Provider Relations Management team to effectively achieve market targets while collaborating with internal departments to drive improvement of provider performance.
Leads and develops team of Provider Relations Managers and/or Network Performance advisors to meet/exceed provider performance and provider satisfaction key metrics.
Conducts field rides with Provider Relations Representatives to gauge their performance and provide coaching and development in order to improve the business results.
Identifies team skill set deficiencies and implements proper professional development plans.
Monitors Provider Performance action plans and tracks provider performance improvement.
Ensures compliance with enterprise provider performance and relationship model and team engagement of provider performance reporting.
Drives improvement of provider performance by analyzing, interpreting and communicating financial, utilization and quality metrics.
Establishes and leads collaborative effort with internal cross-functional market and shared services departments to support provider performance and resolve network and operational barriers/challenges.
Responsible for understanding HEDIS and STARS measures and partners with Quality Team to drive improvement of quality provider performance.
Responsible for understanding the differences between Risk and Value-Based contractual arrangements.
Plans, prepares and executes effective group meetings/discussions with proper objectives and outcomes.
Plans, conducts and directs provider contractual terms and provider account management.
Assists in monitoring and developing High Performing Practices and drives Network Transformation Strategies to optimize member outcomes.
Strategizes membership growth and retention for High Performing Practices, sophisticated and/or complex Provider Partnerships.
Maintains compliance for State and CMS audits.
Resolves high level, complex provider issues.
Member of state senior leadership team.
Special project as assigned or directed. Additional Responsibilities:
Candidate Education: Required A Bachelor's Degree in a related field Candidate Experience: Required 8+ years of experience in provider relations experience
Required 5+ years of management experience.
Pay Range: $148,000.00 - $274,200.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
$148k-274.2k yearly Auto-Apply 8d ago
Market VP, Provider Contracting
Humana 4.8
Remote
Become a part of our caring community and help us put health first The Associate Vice President of Home Health Provider Contracting will lead a focused team responsible for negotiating and managing reimbursement agreements with managed care organizations and health plans across Commercial, Medicare Advantage, Medicaid, and other payer lines of business. This leader will set payment targets, define payer strategy, and operationalize core contracting principles and metrics for the home health business-progressing beyond fee-for-service toward value-based care and innovative payment models (e.g., shared savings, episodic models, capitation, pay-for-performance). The role requires deep experience in payer or managed care contracting and the ability to translate contract terms into financial, clinical, and operational performance. Home health or post-acute experience is preferred but not required.
Key Responsibilities
Oversee payer negotiations end-to-end for home health services: develop strategy, serve as chief negotiator, and secure favorable rates and terms across commercial, Medicare Advantage, and Medicaid contracts, including fee-for-service, episodic, and value-based agreements.
Set annual payment targets and portfolio strategy: define price/volume goals, prioritize payer opportunities, and construct multi-year contracting roadmaps to grow margin and access.
Own contract economics and analytics: oversee financial modeling, valuation, scenario analyses, and pro formas to inform deal strategy and renewals.
Advance value-based contracting: design and implement models such as shared savings, bundled/episodic payments, pay-for-performance, and new service models aligned to home-based care.
Build payer relationships and multi-payer alignment: establish executive-level relationships with plan counterparts; align on quality measures, reporting, and health equity standards to reduce administrative burden and improve outcomes.
Translate contracts into operations: partner with Revenue Cycle, Finance, Clinical, and Operations to implement terms (authorization, billing rules, payment integrity), monitor payer performance, and resolve disputes.
Work closely with Compliance and Legal: manage the papering, review, and signature process for all payer agreements; ensure timely execution, adherence to regulatory requirements, and proper documentation of amendments and renewals.
Develop internal contracting discipline: ensure timely document execution, renewals, amendments, and partner with credentialing as applicable.
Oversee payer performance metrics: track payer scorecards (rates, denials, underpayments, turnaround times), VBC metrics (readmissions, utilization, home health quality measures), and overall portfolio results.
Mentor and develop the team: coach contracting and managed care team members in negotiation tactics, modeling, compliance, and payer relationship management; foster a culture of transparency and results.
Ensure compliance and risk management: coordinate with legal on contract language, regulatory updates, and accreditation requirements; monitor adherence to CMS and payer policies.
Company Overview
CenterWell, a Humana company, creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
The Home Solutions business segment is comprised of two major brands - CenterWell Home Health (CWHH) and OneHome (OH) with ~11,000 associates dispersed across more than 350 locations nationwide.
About CenterWell Home Health: CWHH specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
About OneHome: OH coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients' homes. OneHome's patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OH was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family
Use your skills to make an impact
Key Candidate Qualifications
Required: 7+ years in payer or managed care contracting on the provider or plan side, including direct negotiation of reimbursement rates and contract terms; leadership experience managing a contracting team.
Preferred: Experience in a multi-market or matrixed organization in home health, post-acute, or similar home-based services.
Demonstrated expertise in value-based care, with hands-on design/implementation of alternative payment models (shared savings, bundles, pay-for-quality, capitation/PMPM), and familiarity with CMS value-based programs.
Strong financial acumen: advanced proficiency in contract valuation, pricing analytics, and risk modeling; ability to translate clinical performance to economics and operational impacts.
Relationship and influence skills: proven ability to build executive-level partnerships with health plans and internal leaders (Finance, Clinical, Ops, Revenue Cycle) to achieve contracting goals.
Ability to translate contract performance into actionable insights for leadership.
Education: Bachelor's degree required (Health Administration, Business, Finance, or related); Master's preferred (MBA/MHA).
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.
$184,800 - $254,100 per year
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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 03-26-2026
About us
About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
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.
$184.8k-254.1k yearly Auto-Apply 8d ago
Regional VP, Health Services
Humana 4.8
Remote
Become a part of our caring community and help us put health first As the Regional VP of Health Services, you will serve as the senior clinical executive responsible for shaping and executing the region's clinical engagement strategy. This role drives quality improvement, cost efficiency, and population health outcomes through strategic provider partnerships, data-informed decision-making, and cross-functional collaboration. The RVP acts as a key advisor, innovator, and relationship builder, ensuring alignment with Humana's mission and Medicare Advantage goals.
Primary Responsibilities:
Clinical Engagement & Provider Strategy:
Cultivate and maintain trusted relationships with CMOs and senior executive/clinical leaders at provider and care delivery partner organizations. First and foremost, this is a role focused on building relationships with providers, and then leveraging those relationships to collaborate on how to positively drive provider performance, overcome operational barriers and reduce administrative burden.
Serve as lead clinical executive for provider groups, translating clinical and quality priorities into actionable strategies. This includes promoting growth strategies and innovation with all provider groups, particularly our CenterWell partners.
Enhance innovation with hospital systems while fostering collaboration and reducing operational barriers.
Drive population health initiatives to improve the health and well-being of our members including:
A strong understanding of clinical metrics and data (e.g. Quality measures, Risk Adjustment ratings, chronic condition management, PCP visit rates and effectiveness, and member engagement strategies).
Identifying and implementing initiatives to address total cost of care drivers.
Championing condition-based interventions.
Leading clinical strategies to manage unique populations, such as unattributed membership, low income, disabled, or special needs members.
Clinical Strategy & Market Performance:
Serve as the clinical steward for regional medical expense trends, leveraging data to guide interventions, and ensure fiscal accountability.
Collaborate with finance, analytics, and market leadership to identify cost and quality outliers and implement targeted action plans.
Customize strategies to align clinical programs with payer-specific needs (MA, D-SNP).
Provide clinical input into network development, contract negotiations, and delegation oversight.
Serve as clinical subject matter for potential plan design and clinical programs to support continued health plan growth.
Represent the organization in regional health coalitions and community health initiatives.
Collaborate with various operational functions in the centralized utilization management team and other shared services.
Participate in quality governance, peer review, and grievance resolution processes.
Innovation & Transformation:
Partner with national innovation teams to pilot and scale emerging technologies and care models (e.g., remote monitoring, clinical pathways, tech-enabled care).
Lead regional implementation of clinical focused strategic programs.
Collaborate with vendor partnerships and evaluate performance against clinical and financial KPIs.
May also be involved in governance committees and delegation oversight.
Use your skills to make an impact
Qualifications:
Active MD or DO licensure with appropriate training and certification
5+ years clinical practice
5 + years in managed care industry, either provider or payer.
Thorough knowledge of health care utilization and quality metrics and the impact value-based contracting has on provider behavior and performance.
The ability to quickly monitor clinical metrics and convey the impact verbally and in writing.
Proficient communication skills, including interpersonal, written and presentation, and the ability to promote complex material in a way that can be understood and acted upon by others.
Strategic thinker with the ability to balance long-term vision and short-term execution.
Established track record of building successful teams and cross departmental relationships
Travel required 30-35%
Reside within the region's geographic boundaries
Preferred:
Experience in both provider and payer roles
Prior executive level role with successful track record of building external relationships and driving quality and financial results in a collaborative team/matrixed environment
Advanced degree in business, management and/or population health.
#PhysicianCareers
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.
$327,700 - $450,600 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As a wholly owned subsidiary of Humana, CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties.About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our 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, Medicaid, families, individuals, military service personnel, and communities at large.
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.
$132k-203k yearly est. Auto-Apply 24d ago
VP, Foundational Capabilities
Humana 4.8
Remote
Become a part of our caring community and help us put health first The VP, Foundational Capabilities will lead strategic initiatives to transform and advance Stars back to industry leading. This role is responsible for leveraging emerging technologies, innovative provider and member engagement strategies, and effective external partner collaboration to drive exceptional performance across all current and future proposed Stars measures. This high visibility role will work to ensure the organization remains agile, forward-thinking, and aligned with industry best practices and regulatory requirements.
Competitive Intelligence
Continuously monitor and analyze industry trends, CMS updates, competitor activity, and market dynamics that impact the Medicare Stars landscape.
Develop and communicate insights to inform organizational strategy and ensure proactive responses to changes in the regulatory and competitive environment.
Accountable for ensuring top executives are well informed and have the right information on competitive intelligence to make decisions, highlighting risks, opportunities, and recommended actions.
Stars Technology Advancement
Oversee strategy and integration of digital tools, automation, and artificial intelligence to enhance operational efficiency and support data-driven decision making.
Evaluate, select, and implement innovative technology solutions that streamline Stars data capture, analytics and operational impact.
Partner with IT, Digital and Experience teams to ensure emerging opportunities are integrated and feedback loop complete.
Provider and Member Engagement
Develop engagement models to enhance provider connectivity working closely with Interoperability and Provider Connection teams.
Design emerging educational programs and resources that equip providers and members with actionable data, best practices, and compliance guidance.
Establish feedback mechanisms to gather input and continuously improve partnership effectiveness.
Partner Coordination
Serve as the primary liaison between internal teams, external partners, vendors, and regulatory agencies for Stars initiatives.
Lead cross-functional workgroups to align priorities, share knowledge, and ensure accountability in delivering on Stars objectives.
Manage long term strategic planning with strategic partners to ensure value realization and support long-term program success.
Scale
4 directors
Use your skills to make an impact
Required Qualifications
Bachelor's Degree in Business Administration, Health Administration or a related field
Progressive experience in the health solutions industry, with emphasis on leading and managing teams
Prior Medicare/Medicaid experience
Knowledge of HEDIS/Stars and CMS quality measures
Prior managed care experience
Proficiency in analyzing and interpreting healthcare data and trends
Strong attention to detail and focus on process and quality
Excellent communication skills
Ability to operate under tight deadlines
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
Master's degree in business administration, Health Administration or a related field
5 or more years of Stars experience
Proven organizational and prioritization skills and ability to collaborate with multiple departments
PMP certification a plus
Six Sigma Certification also a plus
Experience with AI and emerging Digital/Technology solutions
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
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.
$153k-222k yearly est. Auto-Apply 18d ago
Associate Director, Cloud Solutions Engineering
Humana 4.8
Remote
Become a part of our caring community and help us put health first The Associate Director of Cloud Infrastructure Operations is responsible for leading Humana's enterprise cloud strategy-focused on the design, implementation, and optimization of cloud compliance, operational excellence, and cost efficiency in a complex multi-cloud environment. This position serves as a strategic advisor and operational leader, collaborating with Application and Product Teams, Cloud Engineering, FinOps, Finance, Legal and Supply Management Services to ensure secure, efficient, and scalable cloud operations.
This position offers a unique opportunity to lead Humana's transformation at the intersection of operations, technology, and AI innovation. The Associate Director of Cloud Infrastructure Operations will drive the evolution of Humana's intelligent infrastructure-enhancing system reliability, security, and compliance while enabling the business to deliver exceptional, patient-centered care.
This leader will also drive the integration of Artificial Intelligence (AI) and Generative AI (GenAI) capabilities into Humana's Infrastructure Operations, blending traditional IT management with next-generation, AI-driven automation and predictive analytics. The role serves as a bridge between operations and innovation-advancing digital transformation, improving system reliability, and ensuring compliance with healthcare regulations such as HIPAA and PHI.
Key Responsibilities:
Provide senior-level leadership and decision-making in developing Humana's overall cloud operations strategy, governance framework, and optimization initiatives.
Establish short-, mid-, and long-term roadmaps for Cloud Production Operations aligned with Humana's enterprise and digital transformation goals.
Oversee operational planning, staffing, and budget management across multi-cloud environments (Azure, GCP, AWS).
Partner with internal stakeholders and Managed Service Providers (MSPs) to ensure operational excellence, service continuity, and adherence to SLAs.
Define and implement ITIL/ITSM frameworks for Incident, Problem, Change, Event, Access, and Knowledge Management, promoting continuous improvement.
Foster collaboration across Humana's technology ecosystem to align cloud operations with business priorities and compliance standards.
Lead and mature the Incident and Problem Management functions to minimize Mean Time to Detect (MTTD) and Mean Time to Resolve (MTTR).
Drive proactive monitoring and operational readiness through the implementation of automated tools and event correlation systems.
Ensure 24/7 operational uptime of mission-critical systems by guiding operational teams, defining SLAs, and improving incident response capabilities.
Lead the MSP teams responsible for daily cloud operations and infrastructure support across Azure, GCP, and AWS.
Partner with Engineering and DevOps teams to integrate CI/CD, automated deployment, and self-healing systems into the operational model.
Maintain operational compliance with security, privacy, and regulatory requirements in healthcare environments.
Develop and execute strategies for cloud compliance, reporting, and cost optimization across all environments.
Deliver tooling, metrics, and dashboards to automate cloud financial management, consumption tracking, and operational reporting.
Partner with FinOps and Finance to provide chargeback, showback, budgeting, and forecasting capabilities, driving financial transparency and accountability.
Identify and standardize processes suitable for automation; collaborate with platform engineering teams to implement solutions that enhance efficiency and reliability.
Drive continuous improvement initiatives that reduce total cost of ownership and improve operational consistency across vendors and service providers.
Maintain relationships with key partners and service providers to identify and implement continuous improvement opportunities in operational performance and cost savings.
Lead research, evaluation, and deployment of AI and GenAI technologies within Humana's Infrastructure Operations.
Explore and prototype AI-driven solutions that automate incident response, predict failures, summarize telemetry data, and assist operations teams through intelligent copilots.
Develop and lead the AI adoption roadmap, integrating predictive analytics, LLMs, and self-healing capabilities into the infrastructure ecosystem.
Integrate AI/ML models into monitoring platforms to enable proactive, data-driven decision-making.
Lead R&D efforts for AI-assisted infrastructure automation, anomaly detection, and capacity forecasting, aligning innovation with operational goals.
Design and maintain automated systems to collect and analyze usage, forecast, and cost data across cloud platforms.
Provide visibility into key performance metrics (SLAs, KPIs, utilization, consumption) that inform operational and strategic decision-making.
Develop and deliver executive-level reports and insights, highlighting operational efficiency, performance trends, and risk indicators.
Identify and address operational gaps by analyzing trends, patterns, and outliers in infrastructure and application performance data.
Create and maintain comprehensive operational documentation, including playbooks, dashboards, and analytical summaries.
Use your skills to make an impact
Required Qualifications:
Bachelor's or Master's degree in Computer Science, Healthcare Informatics or a related field.
10+ years of experience in infrastructure operations or engineering, including 2+ years of leadership in AI/ML or GenAI R&D.
Proven record managing NOC or Command Center teams with responsibility for 24/7 availability and mission-critical systems.
Advanced knowledge of public cloud platforms (Azure, GCP, AWS) and hybrid infrastructure architectures.
Expertise in cloud observability, monitoring, and incident response tools and practices.
Hands-on experience with automation and scripting tools (Terraform, Ansible, PowerShell, Python, Bash, or similar).
Proficiency in cloud cost management tools (Cloudability, Azure Pricing Calculator, AWS Cost Explorer, Power BI).
Strong understanding of ITIL/ITSM principles and practical experience applying them in complex enterprise environments.
Excellent analytical, organizational, and communication skills, with the ability to engage and influence at all levels.
Ability to operate in a lean, agile, and fast-paced organization while balancing long-term strategic goals.
Availability to support off-hours operations as required in a 24/7 enterprise setting.
Preferred Qualifications:
Advanced understanding of cloud platforms, consoles, and services (Azure, Google and AWS).
Deep understanding of the key concepts and practices of cloud observability, coupled with experience implementing robust systems that leverage metrics, logs, and traces to provide holistic state of the cloud operations.
A technical business acumen that ensures the organization is operating efficiently and effectively in a hybrid cloud environment.
Solid understanding of infrastructure and operation landscape with a focus on public cloud (Azure, GCP and AWS) technology and how it differs from traditional computing.
Ability to work with minimal supervision, making decisions based upon priorities, schedules and an understanding of business initiatives.
Passion for and skills in resource optimization to improve cloud efficiency.
Ability to apply critical thinking to all aspects of the position.
Detail oriented with excellent documentation skills/methodologies, who is able to successfully manage multiple priorities.
Proficiency in developing repeatable and efficient automation to codify and simplify end-to-end processes and methods in public and private cloud landscapes.
You have a deep understanding how to apply best practices around monitoring, alerting, and logging, and have implementation experience with one or more monitoring, alerting, and logging systems (Azure Monitor, Log Analytics, Splunk, Dynatrace, SentryOne, etc…).
Deep understanding of core public & private cloud billing, cost management, and data visualization tools (e.g. Cloudability, Azure Pricing Calculator, AWS Cost Explorer).
Senior experience in Ansible, API queries, and Power BI is a plus.
Knowledge scripting using Python, as well as Perl, PowerShell, JavaScript, or similar scripting languages.
Strong analytical and reporting skills.
Leader and a team player with transformation mindset.
Strong organizational, task, and project management skills.
Self-driven and able to work across diverse technical and non-technical teams.
Strong written, verbal and interpersonal communication skills.
Ability to operate successfully in a lean, agile, and fast-paced organization.
Ability to communicate at all levels within an organization and influence leadership.
Azure and/or AWS certifications preferred
Additional Information
Work-At-Home Requirements
WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
#LI-Remote
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.
$156,600 - $215,400 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 01-29-2026
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
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.
$156.6k-215.4k yearly Auto-Apply 16d ago
Associate Director, Technology Solutions
Humana 4.8
Remote
Become a part of our caring community and help us put health first The Associate Director, Technology Solutions devises an effective strategy for executing and delivering on IT business initiatives. The Associate Director, Technology Solutions requires a solid understanding of how organization capabilities interrelate across department(s).
Associate Director, Technology Solutions
Humana Military End User Experience & Incident Management
The Associate Director, Technology Solutions provides strategic and operational leadership for Humana Military's End User Experience and Incident Management functions. This role is accountable for delivering a consistent, high-quality end user experience while maturing incident management practices to reduce disruption, friction, and repeat issues across the organization.
This leader will oversee day-to-day support operations while also driving longer-term improvements by identifying incident trends, partnering with engineering teams to resolve systemic issues, and strengthening processes that improve reliability and responsiveness. A core focus of this role is developing the team's capabilities, building a culture of accountability and continuous improvement, and ensuring support practices align with Humana Military's broader technology and business objectives.
Key Responsibilities
End User Support & Operations
Provide leadership and direction for Desktop End User Support and Incident Management teams, ensuring timely, effective resolution of incidents and requests.
Ensure consistent delivery of high-quality support services that prioritize end user experience, stability, and productivity.
Establish clear expectations, operating rhythms, and service standards across support functions.
Incident Management Maturity
Lead the continued maturation of Incident Management practices, including major incident response, escalation models, and post-incident reviews.
Identify recurring incidents and systemic issues that impact Humana Military users, working closely with engineering and platform teams to drive issues to permanent resolution.
Partner with stakeholders to reduce end user friction through proactive problem identification and prevention.
Trend Analysis & Continuous Improvement
Analyze incident and support data to identify trends, risks, and opportunities for improvement.
Translate insights into actionable plans that improve reliability, reduce repeat incidents, and enhance the overall user experience.
Define and evolve metrics that measure service effectiveness, incident health, and operational performance.
Collaboration & Stakeholder Engagement
Serve as a key partner to engineering, infrastructure, security, and product teams to align support insights with technical roadmaps.
Communicate clearly and effectively with leaders and partners across the organization, providing visibility into issues, risks, and progress.
Represent End User Support and Incident Management in cross-functional discussions and initiatives.
People Leadership & Team Development
Develop and mentor managers and team members, building strong technical, analytical, and leadership capabilities.
Foster a culture of ownership, learning, and continuous improvement.
Support career growth and succession planning within the team.
Use your skills to make an impact
Required Qualifications
Experience with Layer 2 and Layer 3 network architecture and design (LAN/WAN).
Familiarity with cloud network architectures, implementations, and support across platforms such as AWS, Azure, and GCP.
Demonstrated experience leading and developing technical support and/or service delivery teams.
Experience supporting virtualization technologies such as Citrix and VMware.
Experience with workstation imaging, patching, and Group Policy management.
Strong working knowledge of IT Service Management frameworks, including ITIL, with applied experience improving incident and problem management practices.
Excellent verbal and written communication skills, with the ability to engage effectively with technical teams, business partners, and senior leaders.
Preferred Qualifications
Master's degree
Additional Information
Work-At-Home Requirements
WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
#LI-Remote
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.
$142,300 - $195,700 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
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.
$142.3k-195.7k yearly Auto-Apply 25d ago
Associate Director - End User Compute Virtual
Humana 4.8
Remote
Become a part of our caring community and help us put health first The Associate Director end user virtual space will provide strategic and operational leadership for the Tier 0 Virtual Apps Platform L3 Infrastructure team, ensuring reliable, secure, and high-performing virtual applications services that underpin Humana's most critical business operations.
The Associate Director in the End User Compute Virtual space is responsible for leadership of the Virtual Access, Desktops and Application environment for the enterprise. They will also foster a culture of accountability by ensuring the team has the skills needed to deliver the outcomes with high quality, cultivating an environment of respect and collaboration, and embracing modern engineering practices.
Key Responsibilities:
Direct and oversee all Tier 0 Virtual Apps Platform infrastructure operations, including incident management, problem resolution, change control, and continuous improvement initiatives.
Develop and maintain disaster recovery and business continuity plans for the Virtual Apps Platform services.
Ensure compliance with Humana's security, regulatory, and privacy standards, including SOX, HIPAA, and internal audit requirements.
Lead cross-functional collaboration with application owners, security, network, and support teams to deliver seamless end-user experiences.
Serve as the escalation point for high-severity Virtual Apps Platform incidents, driving resolution and root cause analysis.
Oversee performance monitoring, capacity planning, and optimization of Virtual Apps environments.
Champion automation and service reliability engineering principles across the Virtual Apps Platform.
Prepare and present operational, risk, and compliance reports to executive leadership.
Use your skills to make an impact
Required Qualifications:
Bachelor's degree in Computer Science, or 5 years of equivalent leadership experience.
7+ years of progressive experience in enterprise infrastructure.
Demonstrated experience managing Tier 0/critical systems and services.
5+ years' experience in people leadership, including team development, performance management, and talent acquisition.
Strong understanding of ITIL principles, incident/problem/change management, and service level agreements.
Familiarity with compliance requirements such as HIPAA, SOX, and Humana's internal policies.
Proficiency in automation/scripting (e.g., PowerShell, Ansible) and monitoring tools.
Excellent communication, stakeholder management, and executive reporting skills.
Ability to participate in 24x7 on-call rotation for critical incidents.
Commitment to Humana's core values, including inclusion, integrity, and service excellence.
Preferred Qualifications:
Master's degree and/or relevant certifications (e.g., Azure Virtual Desktop Specialty, VMware Certified Professional, ITIL, PMP, CISSP).
At least 3 years in Virtual Apps Platform administration at an L3/expert level in a large, regulated environment.
Experience in cloud-hosted Virtual Apps deployments (Azure, AWS, Citrix or similar).
Expert knowledge of Virtual Apps Platform technologies (e.g.,Citrix, Microsoft Azure Virtual Desktop, VMware Horizon, or comparable solutions) and related infrastructure (Windows Server, Active Directory, networking, security).
Prior leadership of teams supporting healthcare or other highly regulated industries.
Experience driving transformation initiatives (cloud migration, automation, DevOps).
Work-At-Home Requirements
- WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
- A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
- Satellite and Wireless Internet service is NOT allowed for this role.
- A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
#LI - Remote
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.
$129,300 - $177,800 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 02-12-2026
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
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.
$129.3k-177.8k yearly Auto-Apply 7d ago
Associate Director, Configuration Management
Humana 4.8
Remote
Become a part of our caring community and help us put health first The Associate Director, Service Offering Management enables and assures the management and abilities of the service offering system are controlled, balanced and aligned to the mission and needs of the whole enterprise. The Associate Director, Service Offering Management requires a solid understanding of how organization capabilities interrelate across department(s).
The Associate Director, Configuration Management enables and assures the management and abilities of the service offering system are controlled, balanced and aligned to the mission and needs of the whole enterprise. The Associate Director, Configuration Management requires a solid understanding of how organizational capabilities interrelate across department(s). This ITSM Operations position leads Configuration Management Operations (Data Quality, Governance, APM, and Discovery). This highly visible role has the following primary responsibilities:
Own the execution and continuous improvement of the IT Configuration framework including governance and control standards, processes, and procedures
Lead and define CMDB Data Quality strategic initiatives, goals, and OKR's
Support other ITSM processes such as Incident, Change, and Asset Management to consistently align to CMDB process and data requirements
Define Configuration Management Completeness, Correctness, and Compliance goals
Define CMDB Data Owner responsibility and governance standards
Drive Configuration Management Governance and Accountability initiatives across the enterprise
Identify and mange processes to close data quality gaps
Communicate effectively with business stakeholders and technical team members
Identify and drive process automation
Team building and performance management
Use your skills to make an impact
Required Qualifications
Bachelor's Degree
6 or more years of technical experience
2 or more years of management experience
Experience assessing the impact of change on service quality and SLAs.
Experience establishing metrics that can be monitored against a benchmark
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
Masters Degree
Additional Information
Work-At-Home Requirements
WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
Satellite and Wireless Internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
#LI-Remote
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.
$129,300 - $177,800 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
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.
$129.3k-177.8k yearly Auto-Apply 7d ago
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