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Centene jobs in Rancho Cordova, CA

- 57 jobs
  • Palliative Care/Hospice Clinical Specialist

    Centene Corporation 4.5company rating

    Centene Corporation job in Sacramento, CA

    You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Palliative Care/Hospice Clinical Specialist is responsible providing Palliative Care (PC)/Hospice program support and for the coordination of care for members enrolled in Palliative Care/Hospice. This role involves engaging with members, their families, caregivers, PC/Hospice vendors, and health care providers to ensure optimal care and support. The coordinator will act as a subject matter expert in Palliative Care/Hospice, facilitating advanced care planning discussions, and ensuring smooth transitions between care settings. + Coordination of care for Palliative Care/Hospice members + Engage with members, family members and/or caregivers as appropriate + Engage with providers regarding program benefits and communicate member needs + Participate in UM and CM clinical rounds to identify potential members + Collaborate with internal and external partners (hospitals, vendors, physician groups, internal departments (CM, UM, Analytics, etc.) + Education about Palliative Care/Hospice, symptom management, disease process, guidelines and act as a Palliative/Hospice Care Subject Matter Expert (SME) + Facilitate advanced care planning discussion with members, families and/or caregivers. + Assist in processing palliative care/hospice care referrals + Maintain internal program tracker and regulatory requirement responsibilities + Assist in preparation for and attend JOMs - monthly or quarterly as scheduled + Ensure appropriate care transitions from different settings (acute vs. Skilled Nursing Facility (SNF)) or from different programs (Palliative Care or Hospice). + Monitor Palliative Care/Hospice vendor performance and escalate red flag issues + Reconcile Palliative Care/Hospice invoices to be processed for payment + Document all interactions in the electronic health record system. + Stay updated with the latest Palliative Care/Hospice practices and guidelines through continuous education and training. + Performs other duties as assigned. + Complies with all policies and standards. **Education/Experience:** Current state RN Licensure required. 2+ years in Palliative and Hospice required. Associate's Degree Nursing required 2+ years Palliative Care and Hospice required **Licenses/Certifications:** CA RN License required Pay Range: $55,100.00 - $99,000.00 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
    $55.1k-99k yearly 60d+ ago
  • Regional Agency Manager

    Centene 4.5company rating

    Centene job in Stockton, CA

    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 Regional Agency Manager is a field-based position. Ideal candidates will be based within a commutable distance to Fresno, San Joaquin, Stanislaus, or San Francisco counties and also able to travel across the state as needed.*** Meets or exceeds assigned annual sales goals and penetration of the Medicare book of business. Travels within market to engage with local community based organizations, providers, brokers and agencies Investigates and responds to escalated issues for assigned accounts Participates in and conducts Medicare product training Develops best practices and work to implement those based on local market conditions Maintains strong familiarity with competition, market environments, healthcare economics, etc. Builds relationships internally with various departments and teams Serves as subject matter expert in growing Medicare product lines Submits reports upon request and in a timely manner Education/Experience: Bachelor's degree in Healthcare, Marketing, Business or related field or equivalent experience. 2+ years of experience in Sales, Healthcare, Medicare, CMS Regulations and/or Management. Prior experience working with brokers/agents along with territory management experience is preferred. License/Certification: Active, valid and unrestricted State Life, Health & Disability license. For Medicare/Commercial Solutions: Must have a valid driver's license. Travel: As a field-based role, a minimum of 75% of this role will take place in the marketplace. (Note: Working in an office or remotely within a home-based environment is not considered field-based work. Overnight travel maybe required based on territory/marketplace. For Medicare/Commercial Solutions: License/Certification: Active health insurance license required or obtained within 45 days. Requires state insurance license required. Requirements vary state by state. For Health Net of California only: must obtain State Life, Health & Disability license within 45 days of hire. Pay Range: $55,100.00 - $99,000.00 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
    $55.1k-99k yearly Auto-Apply 60d+ ago
  • Sales Assistant III Com

    Centene Corporation 4.5company rating

    Centene Corporation job in Sacramento, CA

    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 Sales Assistant III is responsible for providing sales and service support to achieve sales retention, growth and profitability goals. + Assists Account Executives/Account Managers with development of sales/renewal strategy to achieve growth and retention targets. + Develops and maintains successful employer group and agent relationships, including benefit decision-makers and administrative personnel. + Provides phone and email back-up for sales managers, Account Executives and Account Managers. + Responds to phone and e-mail inquiries from internal and external customers in regards to sales/service issues. + Resolves customer and agent issues through research and investigation with internal departments, promoting and improving customer service and satisfaction. + Develops and completes new and renewing business proposals. Ensures accuracy of new business group quote request forms and group renewal request forms, including contacting agents to obtain any missing data. + Develops and maintains a professional working relationship with underwriting, resolving new and renewal plan option questions/issues for agents and clients. + Assists Account Executives with follow up phone call program for prospects. + Ensures successful implementation of renewals and new groups ensuring accurate enrollment packet requests, completion of mapping and coding, and other related processes. + Provides support during enrollment process, which may include participating in new and renewing group enrollment meetings and health fairs. + Oversees SEHI renewals, including interaction with underwriting on issues and options. + Successful completion of SEHI service program. + Tracks quotes, new and renewing group information through the sales database. **Education/Experience:** College degree desirable. Minimum three years health insurance/managed care sales support experience or similar experience in the health insurance/managed care field **License/Certification:** Valid health and life license preferred in applicable state(s) Pay Range: $22.79 - $38.84 per hour 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
    $22.8-38.8 hourly 20d ago
  • Senior Pharmacy Resolution Specialist

    Centene Corporation 4.5company rating

    Centene Corporation job in Sacramento, CA

    You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Senior Pharmacy Resolution Specialist will act as a subject matter expert and handles more complex pharmacy issues and respond to escalated calls from members, provider/physician's offices and pharmacies. This role will make outbound calls and enters pharmacy overrides into systems based on approved guidelines and approvals provided from clinical pharmacists. + Takes member/prescriber/pharmacist inquiry calls for benefit questions including prior authorization requests + Offers options including submission of a prior authorization request + Thoroughly researches issues and takes appropriate action to resolve them using the appropriate reference material within turnaround time requirements and quality standards + Answers and conducts inbound and outbound calls with members and provider offices to provide resolution to claims (i.e.: additional information requests and medication determination updates) + Thoroughly researches issues and takes appropriate action to resolve them within turnaround time requirements and quality standards + Assists team members often guiding them to the appropriate resolution of more complex and difficult inquiries + Participates in the training of less experienced staff, including opportunity for job shadowing + Acts as a liaison between internal departments on data gathering and problem solving while investigating problems of an unusual nature in the area of responsibility + Presents proposed solutions in a clear and concise manner + Assists with audit preparation as needed + Assists with miscellaneous special project work as assigned + Performs other duties as assigned + Complies with all policies and standards **Education/Experience:** High School Diploma / GED 2 years of experience Call center / customer service experience Experience in healthcare environment (pharmacy operations, managed care, pharmacy hospitals and or pharmacy retail settings) **License/Certification:** Pharmacy technician certification preferred Pay Range: $19.04 - $32.35 per hour 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
    $19-32.4 hourly 2d ago
  • Risk Engineering Technical Consultant

    Liberty Mutual 4.5company rating

    Sacramento, CA job

    Provides highly complex consultative services to an assigned group of customers within a specialty segment or territory. Conducts on-site evaluations, evaluates data, and creates/implements service plans to control customer's source of risk, losses and costs. Provides risk assessment services and information to track progress and demonstrate the value of doing business with Liberty Mutual. Serves as a trainer/mentor to less experienced consultants in their specialty area at the discretion of their manager. Enhances the Company's leadership position in the safety field through speaking engagements at conferences and developing key relationships. Provides an array of expert consultative services to an assigned group of customers within a specialized technical area or territory. Conducts on-site evaluations, evaluates data, and creates/implements service plans to control customer's source of risk, loss and/or costs. At the Regional/Division level, provides expert technical support to other risk control employees by advising them about resources available, legislation and applicable regulations, technology, industry trends and effective methods to reduce risk, improve customer satisfaction and demonstrate the value of doing business with Liberty Mutual. Monitors and evaluates the technical quality of risk control services provided by less experienced consultants. Provides coaching, mentoring and training to enhance their development and effectiveness. Collaborates with management in developing policies, procedures, service tools, technical resources, techniques and new products in order to support and enhance the delivery of risk control consulting services. Participates in actively acquiring and retaining profitable business. Identifies new business opportunities for LP services and may design and execute programs that improve results and increase the number and quality of services customers choose to buy. Enhances Liberty Mutual' s leadership position in the safety field and increases brand awareness through speaking engagements at conferences and developing a network of contacts Qualifications Advanced knowledge, skills and experience in a specialized field, service planning and delivery, risk assessment, risk analysis, solutions management and progress measurement. Fully effective interpersonal, writing and other communication skills required to develop and maintain relationships with customers, peers, and industry contacts. Demonstrated ability to retrieve and enter information using various proprietary software applications and create/modify documents and complex spreadsheets using Microsoft Office suite. The knowledge, skills and other capabilities required are typically acquired through a bachelor degree with coursework in math, engineering or related areas (or equivalent) and at least 8 years of directly related consulting experience in risk control or progressive safety/heath field. Candidates are typically working towards (or obtained) an advanced degree and/or professional certification in one or more of the following areas: CSP, ARM, CRM, CPCU, CIH, or CPE. Position requires regular travel. About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices California Los Angeles Incorporated Los Angeles Unincorporated Philadelphia San Francisco We can recommend jobs specifically for you! Click here to get started.
    $101k-131k yearly est. Auto-Apply 29d ago
  • Strategy Advancement Advisor

    Humana 4.8company rating

    Sacramento, CA job

    **Become a part of our caring community and help us put health first** Humana is a publicly traded, Fortune 100 health benefits company with a long history of successful innovation and reinvention. It has transformed itself from the largest US nursing home company in the 60's, to the largest US hospital corporation in the 80's, to a leading health benefits company beginning in the 90's. Today, Humana is a leader in consumer-focused health solutions and is one of the largest health benefits organizations in the country. Consumer Segment Team Identifying and delivering new avenues of growth is a critical company priority. The Consumer Segment team is an entrepreneurial, multi-functional team within Humana's Medicare and Medicaid business unit. The team is focused on driving industry leading membership growth, retention and health outcomes by identifying new consumer insights, developing growth strategies, and activating them across the enterprise to serve the unique needs of prioritized segments. Humana is seeking an experienced team member with meaningful strategy consulting or healthcare strategy experience to join this team. As Strategy Advancement Advisor, you will support development and implementation of consumer segment strategies that drive growth and retention while optimizing member experience and outcomes. You'll collaborate with teammates and cross-functional partners to frame up business questions, conduct analyses, and recommend solutions. You will help answer key strategic business questions that arise during the annual product/sales cycle across multiple domains, including product design, plan footprint, marketing and sales performance, membership analytics, customer/provider satisfaction and more. You will proactively identify new consumer insights and create business cases to support new pilots and initiatives to address critical unmet consumer needs. **Key Responsibilities Include** : + Managing analysis and/or work streams within high-profile, high-impact strategy projects + Conducting industry, market, competitor, and financial analysis and deliverables that clearly frame objectives, issues/challenges, and articulate compelling, insightful findings, conclusions, and recommendations + Conducting interviews, working sessions, and report-outs with associates and leaders across the company + Own development and presentation of key deliverables for leadership and cross-functional partners + Innovate new pilots and member experiences to drive growth and improved retention + Support business case development for key initiatives **Use your skills to make an impact** **Required Qualifications** + 7+ years of full-time relevant strategic work experience, ideally post-MBA + Strategy management consulting experience + Experience leading broad initiatives with cross-functional collaboration + Strong problem-solving skills and the ability to perform complex qualitative and quantitative analysis + Experience leveraging consumer insights to design and implement new products/services/solutions + Proficiency in verbal/written communication to senior and executive leadership + Proficient in delivering engaging and informative presentations to diverse audiences **Preferred Qualifications** + MBA, MPH, PhD, or graduate degree in a management field + Prior healthcare industry experience, preferably in the managed care or provider sector 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. $115,200 - $158,400 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: 12-18-2025 **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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
    $115.2k-158.4k yearly 10d ago
  • Clinical Document Improvement Specialist - Sacramento, CA

    Unitedhealth Group Inc. 4.6company rating

    Sacramento, CA job

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Clinical Document Improvement Specialist (CDS) is responsible for providing CDI program oversight and day to day CDI implementation of processes related to the concurrent review of the clinical documentation in the inpatient medical record of Optum 360 clients' patients. The goal of the CDS oversight and practice is to support the CDI manager function by providing staff oversite, serve as an additional resource as well as perform CDI role function. The CDS assess the technical accuracy, specificity, and completeness of provider clinical documentation, and to ensure that the documentation explicitly identifies all clinical findings and conditions present at the time of service. This position collaborates with CDI manager, providers and other healthcare team members to make improvements that result in accurate, comprehensive documentation that reflects completely, the clinical treatment, decisions, and diagnoses for the patient. The CDS utilizes clinical expertise and clinical documentation improvement practices as well as facility specific tools for best practice and compliance with the mission/philosophy, standards, goals and core values of Optum 360. This position does not have patient care duties, does not have direct patient interactions, and has no role relative to patient care. This will be an office position located at Mercy General Hospital in Sacramento, CA. Primary Responsibilities: * Provides expert level review of inpatient clinical records within 24-48 hours of admit; identifies gaps in clinical documentation that need clarification for accurate code assignment to ensure the documentation accurately reflects the severity of the patient condition and acuity of care provided * Conducts daily follow-up communication with providers regarding existing clarifications to obtain needed documentation specificity * Provides expert level leadership for overall improvement in clinical documentation by providing proficient level review and assessment, and effectively articulating recommendations for improvement, and the rational for the recommendations * Actively communicates with providers at all levels, to clarify information and to communicate documentation requirements for appropriate diagnoses based on severity of illness and risk of mortality * Performs regular rounding with unit-based physicians * Provides face-to-face educational opportunities with physicians on a daily basis * Provides complete follow-through on all requests for clarification or recommendations for improvement * Leads the development and execution of physician education strategies resulting in improved clinical documentation * Provides timely feedback to providers regarding clinical documentation opportunities for improvement and successes * Ensures effective utilization of the Midas Clinical Documentation Improvement Focus Study, documenting all verbal, written, electronic clarification activity * Utilizes only the Optum360 approved forms, whether paper or electronic * Proactively develops a reciprocal relationship with the HIM Coding Professionals * Coordinate and conducts regular meeting with HIM Coding Professionals to monitor retrospective query rate and address issues * Engages and consults with Physician Advisor when needed, per the escalation process, to resolve provider issues regarding answering clarifications and participation in the clinical documentation improvement process * Actively engages with Care Coordination and the Quality Management teams to continually evaluate and spearhead clinical documentation improvement opportunities You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * 5+ years acute care hospital clinical RN experience OR Foreign Medical Graduate with CDI experience * 2+ years of experience in clinical documentation improvement * Demonstrated proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records * Experience communicating & working closely with Physicians Preferred Qualifications: * BSN degree or equivalent * CCDS, CDIP or CCS certification * Experience in case management and/or critical care * Ability to lead projects with complex responsibilities and timelines * Leadership experience Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
    $71.2k-127.2k yearly 15d ago
  • Area Administrator - Home Health

    Unitedhealth Group Inc. 4.6company rating

    Sacramento, CA job

    Explore opportunities with [agency name], a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together. As the State Director, you are responsible for oversight of assigned region as it relates to implementation and maintenance of administrative practices, agency philosophy, goals, and policies which assure compliance with applicable state and federal regulations, coordinating and completing assigned projects to effectively support the immediate and long range objectives of the company, enhancing the profitability of assigned agencies, and providing motivation and retention of a qualified staff and assure the quality of services delivered. This position also acts as a liaison with management staff and other departments throughout the company. Primary Responsibilities: * Provide leadership and mentoring to agency Executive Directors to ensure profitability and high-quality client care * Oversee QAPI planning, reporting, and improvement initiatives, including complaints, trends, and satisfaction scores * Manage financial performance, including budgeting, metrics, billing, productivity, and growth targets * Drive business development through community engagement and referral relationship building * Ensure compliance with all regulations, laws, policies, and company standards * Oversee staffing, education, evaluations, and approve personnel decisions in collaboration with HR * Act as a liaison with the Home Office and business contacts to ensure operational and quality performance You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * 3+ years of documented experience in a professional clinical discipline or in a healthcare management/administrative role which included operational/financial oversight, and census growth of a healthcare facility or multi-site facility * Driver's License and access to reliable transportation Preferred Qualifications: * Bachelor's or master's degree in nursing or other health care administration or management field * Experience in home health or home and community-based services Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $110,200 to $188,800 annually based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
    $51k-64k yearly est. 3d ago
  • Insurance Strategy Consultant

    Humana 4.8company rating

    Sacramento, CA job

    **Become a part of our caring community and help us put health first** Humana, a Fortune 50 Healthcare Company Humana is a publicly traded, Fortune 50 healthcare company with a long history of successful innovation and reinvention. It has transformed itself from the largest US nursing home company in the 60's, to the largest US hospital corporation in the 80's, to a leading health benefits company beginning in the 90's. Today, Humana is a leader in consumer-focused health solutions and is one of the largest health benefits organizations in the country. The Healthcare Strategy team supports Humana's Insurance segment. This segment, Humana's largest, comprises the majority of the company's total revenue and earnings. Team members partner with senior leaders of the business unit, and more broadly with leaders throughout the enterprise, as they deliver strategy projects addressing some of the businesses' most important opportunities and challenges. These high-profile strategy projects place the team at the forefront of helping to define the future of Humana's largest businesses. Humana is seeking a team member, with prior management consulting experience or professional experience leveraging core consulting skills, to support delivering some of the Insurance segment's highest priority projects and initiatives, with an emphasis on Medicare Advantage strategy development. As a Senior Strategy Advancement Professional, you will deconstruct issues and challenges, perform targeted research and analysis, support core strategy operational work, and craft sound, logical solutions and recommendations. You will also shape implementation considerations, and work with business owners as appropriate to transition analysis into execution. While deep diving into key areas, you will also have a bird's-eye view of the business unit's overall strategy. Your role be instrumental in synthesizing the strategic and operational choices being made across the business unit into coherent plans to drive growth and profitability, while simultaneously improving the lives and health of Humana's members. While doing so, you will have the opportunity to collaborate with fellow team members, subject matter experts, members of Humana's executive Management Team, and corporate, functional, and business unit leaders. Recent example projects include assessing the performance of strategic initiatives and business areas, evolving key facets of the Medicare Advantage growth strategy, leading the development of the annual Medicare Advantage strategic plan, monitoring segment-wide operational performance, and refreshing the strategy for Humana's sales organization. **Use your skills to make an impact** **Key responsibilities include:** + Delivering high quality analysis and deliverables that clearly frame objectives, issues/challenges, and articulate compelling, insightful findings, conclusions, and recommendations + Managing and delivering analysis and workstreams within high-profile, high-impact strategy projects + Developing high quality, insightful, and clear analysis and deliverables for Humana's executive management team and Board of Directors + Developing hypotheses to be validated or refined through targeted research and analysis + Conducting interviews and working sessions with stakeholders across the company + Conducting industry, market, competitor, and financial analysis + Working collaboratively with fellow team members and leaders across the company + Leading critical processes to prepare leadership for interactions with Humana's executive Management Team and Board of Directors + Being a steward of the strategy team's operating model, norms and ways of working + Coordinating and overseeing key meetings to ensure key topics and decisions are communicated to leadership in a timely manner + Defining and developing opportunities for strategic alignment and consistent reporting across the business segment + Partnering with key stakeholders to implement segment-wide tracking tools and databases + Designing and monitoring key metrics and the reporting cadence across the organization + Working across operational units to execute strategic planning process and quarterly refinement **Required Qualifications** + Bachelor's degree + 2+ years of full-time work experience with a leading management consulting firm and/or 3+ years of professional experience in a role that required core consulting skills + Demonstrated ability to manage analysis and work streams + Excellent verbal and written communication abilities + Highly collaborative, flexible, team-oriented working style + Strong problem-solving skills and the ability to perform complex qualitative and quantitative analysis + Demonstrated ability working within a matrixed environment **Preferred Qualifications** + MBA, MPH, PhD, or graduate degree in a management field + Prior healthcare industry experience, preferably in the managed care or provider sector **Reporting Relationships** The role reports to a Director within the Strategy team, works collaboratively with leaders and members of rest of the team, and with senior leadership throughout the enterprise. 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. $86,300 - $118,700 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. Application Deadline: 12-19-2025 **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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
    $86.3k-118.7k yearly 35d ago
  • Supervisor, Utilization Management

    Centene Corporation 4.5company rating

    Centene Corporation job in Sacramento, CA

    You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues + Maintains knowledge of regulations, accreditation standards, and industry best practices related to utilization management + Works with utilization management team and senior management to identify opportunities for process and quality improvements within utilization management + Educates and provides resources for utilization management team on key initiatives and to facilitate on-going communication between utilization management team, members, and providers + Monitors prior authorization, concurrent review, and/or retrospective clinical review nurses and ensures compliance with applicable guidelines, policies, and procedures + Works with the senior management to develop and implement UM policies, procedures, and guidelines that ensure appropriate and effective utilization of healthcare services + Evaluates utilization management team performance and provides feedback regarding performance, goals, and career milestones + Provides coaching and guidance to utilization management team to ensure adherence to quality and performance standards + Assists with onboarding, hiring, and training utilization management team members + Leads and champions change within scope of responsibility + Performs other duties as assigned + Complies with all policies and standards **Education/Experience:** Requires Graduate of an Accredited School Nursing or Bachelor's degree and 4+ years of related experience. Knowledge of utilization management principles preferred. 25% Travel CA RN License Required **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State Licensure required Pay Range: $73,800.00 - $132,700.00 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
    $73.8k-132.7k yearly 60d+ ago
  • Associate Actuary

    Humana 4.8company rating

    Sacramento, CA job

    **Become a part of our caring community and help us put health first** The Associate Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Establishes metrics, provides data analyses, and works directly to support business intelligence. Evaluates industry, economic, financial, and market trends to forecast the organization's short, medium and long-term financial and competitive position. The Associate Actuary, Analytics/Forecasting work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Associate Actuary, Analytics/Forecasting ensures data integrity by developing and executing necessary processes and controls around the flow of data. Collaborates with stakeholders to understand business needs/issues, troubleshoots problems, conducts root cause analysis, and develops cost effective resolutions for data anomalies. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. **In addition, the Associate Actuary will:** + Support long term projects aimed at advancing technical maturity, process efficiency, and forecasting accuracy. We are looking for creativity, curiosity, and a desire to explore and influence uncharted territory. + Conduct independent research, collaborate across many teams/departments, and require strong communication skills to be successful in the job. **Use your skills to make an impact** **Required Qualifications** + Bachelor's Degree + Associate of Society of Actuaries (ASA) designation + Meets eligibility requirements for Humana's Actuarial Professional Development Program (APDP) + MAAA + Strong communication skills + Demonstrated ability to communicate technical information with audiences not in the actuarial space + Must be passionate about contributing to an organization focused on continuously improving consumer experiences + 3+ years health industry experience with ASA, or 1+ years health industry experience with FSA + 2+ years SQL experience, or equivalent skillset **Preferred Qualifications** + Medicare Advantage background + Creative, high degree of self-accountability + Experience in Python, PowerApps, and PowerBI 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. $106,900 - $147,000 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: 12-30-2025 **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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
    $106.9k-147k yearly 27d ago
  • Business Lines Territory Manager

    Liberty Mutual 4.5company rating

    Sacramento, CA job

    Owns and manages an assigned territory, driving profitable premium growth to achieve financial and operational goals. Under limited to moderate supervision, manages broad and diverse agency partnerships, handles 200+ agency storefronts potentially over multiple states, and optimizes territory performance. Creates, implements and executes territory and agency strategies to achieve goals using all company programs, tools and resources while collaborating with internal business partners. Conducts agency outreach primarily virtually, via audio or video conferences, supplemented by email and other digital media. Line of business emphasis on business lines, working across a wide breadth of commercial products, coverages and market appetite. Works closely with agents and brokers to drive flow of small commercial business. Balances engagement with agents and brokers to secure larger targeted accounts and managing account pipeline end-to-end. Manages renewal processes and works across multiple underwriting segments. Owns and manages assigned territory driving profitable growth to achieve financial and operational targets. Leads territory and agency management processes across multiple territories (e.g. Agency prospecting, business planning, engagement, training, compensation, plant optimization, etc). Builds and cultivates mutually beneficial agency partnerships virtually with agency ownership, management and frontline staff. Establishes position as a trusted advisor while delivering product, underwriting philosophy, appetite and system training, support retention and new business development to increase depth and maximize agency revenue. Using agency analysis, insights, internal partner feedback and local marketplace expertise creates and executes high-quality agency strategies to achieve direct written premium, profit and new business goals. Plans include strategic and tactical components and are aligned with key Personal Lines or Business Lines business strategies including carrier consolidation (book transfer), agency plant expansion, agency marketing & service programs and new product/program rollout support. Under limited to moderate supervision, drives and ensures quality of new business flow, appropriate book mix, and overall risk management of both individual agency books and overall assigned territory. Provides appetite and target market clarity, identifies and addresses profit or quality of business concerns to ensure profitability across territory. Collaborates, influences and supports internal business partners (underwriting/product management/claims/risk control) to identify and capitalize on opportunities, solve problems, share key competitor and industry intel and provide voice of our agent/customer. Collaborates with Personal Lines (PL) or Business Lines (BL) counterparts to effectively partner with shared agency assignments. Strategically utilizes internal and external programs and tools designed to support the Independent Agent channel and Territory Manager agency management including all marketing and development programs, new business development tools and internal production/profitability data and analysis. Provides guidance on agency initiatives and contributes ideas for continuous improvement. Performs other duties as assigned Qualifications Bachelors` Degree or equivalent industry experience. Minimum three+ years of insurance experience within a carrier or agency. Knowledge of company services, products, marketing techniques/principles and insurance industry trends. Exposure of revenue growth and sales success in a prior role. Proven success in developing and building partnerships, decision making and problem solving. Working knowledge of the business including production management, claims, loss prevention, underwriting, administration, sales operations and agency business operations. Highly effective written and oral communication skills, including presentation, persuasion, timing, tact and negotiation skills. High degree of customer focus, interpersonal relationship skills and problem solving. Strong analytical thinking, business analytics and business development skills. Strong time management and team orientation skills. Must be licensed by the state if required. Ability to travel up to 25% with occasional overnight travel. About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: *********************** Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices California Los Angeles Incorporated Los Angeles Unincorporated Philadelphia San Francisco We can recommend jobs specifically for you! Click here to get started.
    $64k-80k yearly est. Auto-Apply 8d ago
  • Senior Accountant - Tax Accounting

    Humana 4.8company rating

    Sacramento, CA job

    **Become a part of our caring community and help us put health first** The Senior Tax Accountant analyzes and interprets tax laws, regulations, GAAP, and Statutory tax accounting principles, and prepare technical reports on how they impact the organization's operations. The Senior Tax Accountant work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Tax Accountant focuses on Federal and State Income, GAAP and Statutory Tax Accounting, Sales and Use, Property and Premium taxes. Maintains tax information and records, prepares tax returns and other required reports, and pay tax declarations so that compliance obligations are submitted accurately and on time. Prepares correspondence with external tax agencies (for example, auditors). Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree: in accounting/finance + 4+ years of relevant tax experience + Experience with predicting liabilities for Federal and/or State tax + Excellent written and verbal communication skills + Strong organization skills - able to manage tax processes, develop work plans, meet deadlines and coordinate with others + Experience with computerized tax software and research programs + Knowledge of federal and state tax law and current developments + Strong Excel proficiency **Preferred Qualifications** + Certified Public Accountant + Master's Degree in Business Administration or a related field + GAAP ASC 740 tax accounting experience or knowledge + Statutory SSAP 101 tax accounting experience or knowledge + Good working knowledge of OneSource Tax Provision software **Additional Informa** **tion** Preferred location is Louisville office/hybrid but would consider remote depending on skills/quals in Eastern or Central time zones. 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. $78,400 - $107,800 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: 01-08-2026 **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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
    $78.4k-107.8k yearly 46d ago
  • Float Pharmacist

    Unitedhealth Group 4.6company rating

    Fairfield, CA job

    **Opportunities with Genoa Healthcare.** A career with Genoa Healthcare means you're part of a collaborative effort to serve behavioral health and addiction treatment communities. We do more than just provide medicine: we change lives for the better. People with serious mental or chronic illness - and those who care for them - have moving stories, and at Genoa we become their voice, their partner. Working as part of a coordinated care team, we partner with community-based providers and others to ensure that people with complex health conditions get the right medications and are able to follow their treatment plans. Our personalized services - in-clinic pharmacies, medication management and more - are leading the way to a new level of care. Genoa is a pharmacy care services company that is part of Optum and UnitedHealth Group's family of businesses. We are part of a leading information and technology-enabled health services business dedicated to making the health system work better for everyone. Join us to start **Caring. Connecting. Growing together.** **Join the Genoa Healthcare Team!** Are you ready to make a difference? At Genoa Healthcare, we're more than just a pharmacy; we're a lifeline for those in need. Our mission is to serve behavioral health and addiction treatment communities, changing lives for the better. We become the voice and partner for people with serious mental or chronic illnesses and those who care for them. As part of our coordinated care team, we work with community-based providers to ensure that individuals with complex health conditions receive the right medications and follow their treatment plans. Our personalized services, including in-clinic pharmacies and medication management, are leading the way to a new level of care. **About Us:** Genoa Healthcare is part of Optum and UnitedHealth Group's family of businesses. We're dedicated to making the health system work better for everyone. Join us and start Caring. Connecting. Growing together. **Position: Pharmacist Float** We're looking for a Pharmacist Float to perform professional duties and responsibilities associated with processing prescriptions. This full-time position guarantees 40 hours per week and involves traveling to our pharmacies to cover for PTO and LOAs for our pharmacists. **You could be working at any of our pharmacy sites in Sacramento, Redding, Chico, Santa Rosa, Fairfield, San Francisco, Fresno, Hanford, and Visalia, CA** . **Perks** : + $0.70 cents/mile + Up to a 10% RRP Bonus + Vision, Dental, and Healthcare + 23 days of PTO with 9 paid holidays + 401k Match + Monday through Friday **Primary Responsibilities:** + Distribute drugs prescribed by physicians and other health practitioners + Provide information to customers about medications and their use + Focus on providing a superior level of customer service + Ensure compliance with all relevant laws of the applicable State Board of Pharmacy + Administer immunizations as allowed by State Boards of Pharmacy + Perform any other usual and customary pharmacy duties **Check Us Out:** Take a virtual tour of one of our pharmacies: Genoa Healthcare On-site Pharmacy Tour - Genoa Healthcare On-site Pharmacy Tour - YouTube You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Bachelor's Degree in Pharmacy or PharmD + Active Pharmacist License in the state of California + Immunization Certification Certificate + Willingness to cover temporarily as PIC if needed + Willingness to complete LAI training and administer LAI + Driver's License and Car Insurance + Willing and able to travel to ALL of our 9 sites; Sacramento, Redding, Chico, Santa Rosa, Fairfield, San Francisco, Fresno, Hanford, and Visalia, CA **Preferred Qualifications:** + Retail Experience + Long Term Care/Assisted Living experience Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $34.23 to $61.15 per hour based on full-time employment. We comply with all minimum wage laws as applicable. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
    $34.2-61.2 hourly 40d ago
  • Director, General Accounting

    Humana 4.8company rating

    Sacramento, CA job

    **Become a part of our caring community and help us put health first** The Director, General Accounting performs general accounting activities, including the preparation, maintenance and reconciliation of ledger accounts and financial statements such as balance sheets, profit-and-loss statements and capital expenditure schedules. Conducts or assists in the documentation of accounting projects. The Director, General Accounting requires an in-depth understanding of how organization capabilities interrelate across the function or segment. The Director, General Accounting prepares, records, analyzes and reports accounting transactions and ensures the integrity of accounting records for completeness, accuracy and compliance with accepted accounting policies and principles. Provides financial support, including forecasting, budgeting and analyzing variations from budget. Analyzes and prepares statutory accounts, financial statements and reports. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy. **Use your skills to make an impact** **Required Qualifications** + Master's Degree + 8 or more years of technical experience + 5 or more years of management experience + Progressive financial and accounting analysis experience + Progressive leadership and management experience + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + Master's Degree in Business Administration + Certified Public Accountant license + Prior experience in public accounting and auditing + Strong technical accounting skills + Prior insurance operations or financial industry experience + Knowledge of relational databases such as Access and SQL Server + Certified Public Accountant license **Additional Information** Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $168,000 - $231,000 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: 12-16-2025 **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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
    $168k-231k yearly 10d ago
  • Channel Development Lead

    Humana 4.8company rating

    Sacramento, CA job

    **Become a part of our caring community and help us put health first** With over 10 million sales interactions annually, Humana understands that while great products are important, it's the quality of our service that truly defines us. We know that when our members and prospects have delightful and memorable experiences, it strengthens their connection with us and enables us to put their Health First. After all, a health services company that has multiple ways to improve the lives of its customers is uniquely positioned to put those customers at the center of everything it does. The Channel Development Lead defines the sales product strategy for single or multiple lines of business targeting specific markets and/or business segments. The Channel Development Lead works on problems of diverse scope and complexity ranging from moderate to substantial. **Typical responsibilities include but are not limited to:** + develops key performance indicators to drive sales program effectiveness and to ensure cost efficiencies. + Provide data driven expertise and management reporting to improve sales performance and increase market share. + Develop go to market strategies and identify new business opportunities to increase overall sales portfolio. + Identify key areas of improvement through trend and utilization analysis. Collaborate closely with business leaders, marketing and finance to ensure effective, strategic, and competitive sales plans. + Advises executives to develop functional strategies (often segment specific) on matters of significance. + Exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. + Uses independent judgment requiring analysis of variable factors and determining the best course of action. **Use your skills to make an impact** **Required Qualifications** + Bachelor's Degree or higher + 3 or more years of experience with intake and governance to involve managing requests, prioritizing work, and ensuring compliance with organizational standards + 2 or more years of project management/leadership experience + Comprehensive knowledge of Microsoft Word, Excel, PowerPoint, and Outlook + Experience collaborating with key stakeholders on strategic initiatives + Experience communicating with strategic level Leaders + Ability to manage multiple projects effectively + 10% travel may be required as business dictates + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + PMP (Project Management Professional) Certification + Experience with Microsoft Planner + Strong financial acumen for budgeting, forecasting, and ROI analysis. + Excellent stakeholder management, communication, and negotiation skills. 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. $115,200 - $158,400 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: 12-18-2025 **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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
    $115.2k-158.4k yearly 13d ago
  • Lead Digital Product Manager - Platform

    Humana 4.8company rating

    Sacramento, CA job

    **Become a part of our caring community and help us put health first** With over 10 million sales interactions annually, Humana understands that while great products are important, it's the quality of our service that truly defines us. We know that when our members and prospects have delightful and memorable experiences, it strengthens their connection with us and enables us to put their Health First. After all, a health services company that has multiple ways to improve the lives of its customers is uniquely positioned to put those customers at the center of everything it does. Our brokerage business is poised to advance the industry in how digital can be used to drive customer acquisition in the Medicare Advantage space. Within this business area, we are aggressively driving new digital capabilities, new ways of working, and employing next-gen technology to revolutionize how Medicare Advantage is sold. This role is part of this expanding Digital organization, and will be critical in our growth plans. **Key Responsibilities:** + Develop the vision and roadmap for the platform and capabilities for this exciting new product, including functionality, performance, results criteria, evolution, and lifecycle, all towards innovatively and aggressively growing our eCommerce acquisition channel. + Provide strategic thought-leadership as a subject matter expert within Enterprise Growth and with partner organizations in the enterprise, on approaches to best-practices in Product Management. Be a leader in how Product Management at the company should be done. + Assess the business and consumer impact of various options and collaborate with the engineering, design, marketing, and sales teams to build business cases, requirements/services, and determine the best prioritization, technical implementation method, and schedule. + Establish hypotheses that enable us to test, learn, and iterate with high speed, enabling supercharged business growth. + Be customer and data obsessed - maintain a deep understanding of the needs and goals of consumers and business to develop requirements, data and features needed to deliver on a best-in-class digital experience. + Create business cases to be prioritized on the roadmap and collaborate with the engineering, design, marketing, and sales teams to build business cases, requirements/services, and determine the best technical implementation method and schedule. + Establish success measures/product/feature KPIs and maintain a deep understanding of the needs and goals of consumers and business to develop requirements, data and features needed to deliver on a best-in-class digital experience. + Proven ability to lead cross-functional teams through influence versus direct management; excellent interpersonal skills. + Structure and lead meetings, clearly communicate expectations, and ensure that stakeholders are adequately updated on progress and milestones. **Use your skills to make an impact** **Required Qualifications** + Expert Digital experience (web, mobile, social and ecommerce) + 7+ years of product management experience, with a focus on technical products and platform experience + Deep user empathy and strong user experience sensibilities + Ability to work well with designers and engineers in an agile environment + An entrepreneurial work style, you're a self-starter + Excellent written and verbal communication skills + Ability to facilitate collaborative decision-making in a workshop setting + An analytical and metrics-driven work style + Natural leadership instincts with proven ability to innovate and influence + Comfort in a fast-paced and dynamic environment 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. $126,300 - $173,700 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. Application Deadline: 12-13-2025 **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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
    $126.3k-173.7k yearly 60d+ ago
  • Strategy Advancement Advisor - Distribution Strategy

    Humana 4.8company rating

    Sacramento, CA job

    **Become a part of our caring community and help us put health first** With over 10 million sales interactions annually, Humana understands that while great products are important, it's the quality of our service that truly defines us. We know that when our members and prospects have delightful and memorable experiences, it strengthens their connection with us and enables us to put their Health First. After all, a health services company that has multiple ways to improve the lives of its customers is uniquely positioned to put those customers at the center of everything it does. The Strategy Advancement Advisor provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for business segments or the company at large. The Strategy Advancement Advisor works on problems of diverse scope and complexity ranging from moderate to substantial. **Become a part of our caring community and help us put health first** The Strategy Advisor (Distribution) provides data-based strategic direction to identify and address business issues and opportunities. Provides business intelligence and strategic planning support for the Enterprise Growth vertical. The Strategy Advisor's work involves complex assignments performed without direction where the analysis of situations or data requires an in-depth evaluation of variable factors. This work may require leading end-to-end strategy engagements. As part of the Strategy Advancement team, this role will support MarketPoint's investment rationalization and strategic planning efforts. The role requires comfort with ambiguity and creating new solutions in the "white space" where answers are not clear cut or readily available. A successful candidate will be someone who has worked for several years in large matrixed organization (e.g. a publicly traded corporation or large not profit organization) or has several years' experience with stakeholder management (strategy/operations at a top-tier consulting/professional services firm). They will have a demonstrated ability to synthesize large amounts of information into clear and concise outputs (PPT, Excel). This person must be comfortable working collaboratively with senior leaders and subject matter experts alike and should have a high degree of executive presence leading engagements with these stakeholders. This person also will be effective at multitasking and possess keen program and change management skills to balance an evolving set of priorities and deadlines. Healthcare experience is a plus, but not required, though must have a history of mastering an understanding of their prior industry. Other examples of the kind of work required from this role include leading the analysis of complex business problems and issues using data from internal and external sources. The candidate should bring expertise or identify subject matter experts in support of multi-functional efforts to identify, interpret, and produce strategic recommendations and plans. The candidate's work will substantially shape the thinking of distribution org. They will exercise independent judgment and decision making on complex issues to determine the best course of action and work under minimal supervision. **Use your skills to make an impact** About the team: Humana's distribution organization, MarketPoint, plays a key part in driving Humana's long-term vision to achieve leading growth in Medicare and individual products. The MarketPoint strategy team was created to help transform Humana's customer acquisition approach. The team functions with a mandate to think creatively, discover new opportunities and re-envision operations to drive growth and deliver a first-class experience to our members and agents. **Responsibilities:** + Leads multiple short- and long-term work streams sometimes across engagements, including hypothesis development, working sessions, and report-outs with leaders across the company, and documenting key ideas and actions to drive follow-up actions + Partners closely with finance, analytics, and operators to optimize, track, and report out on internal and external compensation strategy and results + Develop high-quality analysis and deliverables that clearly frame organizational objectives, issues/challenges, and articulate compelling, insightful findings, conclusions, and recommendations + Lead multiple cross functional investment sizing workstreams and provide high-level support for senior leaders to make informed decisions + Identify new growth avenues of opportunity through independent analysis and presents actionable findings + Lead key portions of presentations at high-visibility meetings + Assist MarketPoint leadership in communicating value and impact of MarketPoint initiatives to broader Humana organization + Coach junior team members to develop technical and professional skillsets **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree + **3+ years** of progressive experience consulting in finance, strategic planning, or related roles. + Proven track record in **building compensation models** and **incentive design frameworks** . + Advanced proficiency in **financial modeling and Excel** + Demonstrated experience **managing large, complex budgets** and guiding senior leadership through **trade-off decisions** . + Strong background in **business case development** , including **value sizing** , ROI analysis, and scenario modeling. + Ability to influence and partner with senior executives to drive strategic decisions. + Exceptional analytical and problem-solving skills with a focus on **data-driven decision-making** . + Strong communication skills to present complex financial concepts clearly to non-financial stakeholders. **Preferred Qualifications** + Healthcare industry experience, preferably in the managed care or provider sector + Experience in **compensation strategy** within large organizations. + Exposure to **enterprise-level budgeting and resource allocation** . **Additional Information** **- Position does have the potential for up to 5% travel.** **- Position will be working Eastern (EST) hours.** **Virtual Pre-Screen** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a HireVue interview. In this interview, you will listen to a set of interview questions over your phone or text and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide their social security number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. **Work-At-Home Requirements** At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. 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. $115,200 - $158,400 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: 12-28-2025 **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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
    $115.2k-158.4k yearly Easy Apply 12d ago
  • Medical Director - Pharmacy Appeals

    Humana 4.8company rating

    Sacramento, CA job

    **Become a part of our caring community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the analysis of situations or data requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and support staff to provide Humana members with optimal value based care in accordance with Medicare and Humana policy. All work occurs within a context of regulatory compliance and work is assisted by diverse resources, included but not limited to CMS policies, National and Local Coverage Determinations, CMS-recognized Compendia, NCCN, Humana Pharmacy Policies and Procedures, and clinical literature as appropriate. Medical Directors will learn Medicare Part D and Medicare Advantage requirements and will understand how to operationalize this in their daily work. The Medical Director's work includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above as well as inter- and intra-departmental resources. Work may include Peer to Peer discussions with prescribers, participation in hearings involving an Administrative Law Judge, support for CMS audits, cross-functional team activities, and other responsibilities as determined necessary to support optimal value based care in accordance with Medicare and Humana policy. **Use your skills to make an impact** **Required Qualifications:** + MD or DO degree + 5+ years of direct clinical patient care experience post residency or fellowship, preferably including some experience related to a Medicare type population (disabled or >65 years of age) + A current and unrestricted license in at least one jurisdiction and willing to obtain additional license, if required + No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements + Excellent verbal and written communication skills + Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, or similar activities **Preferred Qualifications:** + Knowledge of the managed care industry, Integrated Delivery Systems, health insurance, or clinical group practice management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or Commercial health insurance + Current and ongoing Board Certification in Internal Medicine, Family Medicine, Emergency Medicine or Physical Medicine and Rehabilitation + Experience with national guidelines, such as MCG, InterQual, NCCN, Micromedex, Lexicomp, Elsevier's Clinical Pharmacology + Exposure to Public Health, Population Health, analytics, and use of business metrics + Curiosity to learn, flexibility to adapt, courage to innovate + Experience functioning as a Team member, providing support to reach a common goal **Additional Information** May participate on project teams or organizational committees. \#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. $223,800 - $313,100 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: 01-31-2026 **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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
    $223.8k-313.1k yearly 13d ago
  • Actuary, Risk and Compliance

    Humana 4.8company rating

    Sacramento, CA job

    **Become a part of our caring community and help us put health first** The Lead Actuary, Risk and Compliance is responsible for the overall management and oversight of actuaries and/or support staff where activities are concerned with identifying and managing risks. Identifies and analyzes potential risks and estimates the potential financial consequences, develops and recommends controls and cost-effective approaches to minimize risks. The Lead Actuary, Risk and Compliance works on problems of diverse scope and complexity ranging from moderate to substantial. The Lead Actuary, Risk and Compliance assesses and communicates information regarding actuarial/business risks across the organization. Provides peer review and counsel on a wide variety of company, industry, and regulatory practices. Activities may include monitoring developments in actuarial techniques, and researching laws and regulations applicable to actuarial science and insurance operations. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action. In this specific role, you will be part of a team tasked with assessment of risk , opportunities, and mitigation strategies to assure the compliant submission of bids to support Humana's pricing and product development of Medicare Advantage and Prescription Drug Plans that positively impact the financial performance of Humana. + Supporting Humana's MA-PD and PDP bid filings by ensuring appropriate interpretation and implementation of CMS guidance, and implementation and execution of review standards and controls to minimize compliance risk associated with the bid filing + Participate in CMS audits and reviews related to Humana's Medicare bids. + Create and maintain process improvements to bid filings to continually improve Humana's ability to file compliant bids. This position comes with the opportunity of leading a team of 2 direct reports. **Use your skills to make an impact** **Required Qualifications** + a Bachelor's degree + 8 or more years of technical experience + 2 or more years of project leadership experience + Associate or Fellow in the Society of Actuaries + Member of the American Academy of Actuaries + Strong communication skills + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + Medicare Advantage experience + Strong Communication Skills + Ability to manage large projects involving actuarial and non-actuarial staff **Additional Information** Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $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: 12-30-2025 **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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
    $129.3k-177.8k yearly 28d ago

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