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:** Directs the utilization management team to ensure the appropriate application of policy procedures and processes to help support best member outcomes. Oversees and manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider interactions and experience and associated regulatory and/or compliance measures. Oversees the end-to-end management of authorization reconciliation and post claim authorization functions, ensuring seamless coordination between authorization processes, claims reconciliation, and provider case resolution. This role focuses on optimizing operational workflows, enhancing data accuracy, and driving efficiency to support timely and compliant claims outcomes.
+ Leads utilization management team on performance, improvement, and career growth path considerations
+ Leads utilization management team policies and procedures to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards
+ Reviews, analyzes, and reports on utilization trends, patterns, and impacts to deliver an effective utilization program
+ Leads process improvements for the utilization management team to achieve cost-effective healthcare results and presents to senior leadership team
+ Establishes policies and procedures that incorporate best practices and ensure effective utilization reviews of members
+ Develops utilization management strategies and influences decisions by providing recommendations that align to organizational objectives
+ Responsible for components of the department's budget while collaborating inter-departmentally with senior leadership
+ Executes the overall strategy for onboarding, hiring, and training new utilization management team members to ensure adequate training and high quality-care to improve member and provider experience and ensure compliance
+ Leads and champions change within scope of responsibility
+ Partner closely with claims and clinical and non-clinical Utilization Management (UM) team members to align processes and improve end-to-end handling of authorization related claim issues
+ Direct the resolution of authorization-related denials and post claim escalations tied to authorization issues, ensuring timely and accurate outcomes
+ Provide strategic leadership and oversight for provider claim disputes, reconsiderations related to authorizations and/or medical necessity
**Education/Experience:** Requires a Bachelor's degree and 7+ years of related experience, including prior management experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. 4+ years management experience preferred. Expert knowledge of industry regulations, policies, and standards preferred. Knowledge of claims issues related to authorizations highly preferred. Experience with claims disputes and reconsiderations highly preferred.
Pay Range: $133,700.00 - $247,400.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
$133.7k-247.4k yearly 60d+ ago
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Senior Systems Engineer (Digital Employee Experience)
Centene Corporation 4.5
Centene Corporation job in Richmond, VA
You could be the one who changes everything for our 28 million members by using technology to improve health outcomes around the world. As a diversified, national organization, Centene's technology professionals have access to competitive benefits including a fresh perspective on workplace flexibility.
**Position Purpose:**
The Senior Systems Engineer of DEX (Digital Employee Experience) is responsible for ensuring the optimization of the organization's Digital Employee Experience solutions. The Senior System Engineer is also responsible for managing incident escalations and resolving solution outages to minimize business disruption and maximize productivity.
+ Provides direct support and guidance to peers in troubleshooting endpoint related incidents and outages
+ Work closely with peer endpoint teams on root cause analysis of endpoint issues and build long-term preventive solutions
+ Provide occasional after-hours support to critical issues and outages
+ Implement the DEX Strategy that drives continuous improvements of the end user compute experience
+ Support planned and unplanned reporting efforts on status updates to senior and executive leadership
+ Coordinate problem and incident management with 3rd party vendors
+ Mentor, and coach peer multidisciplinary system engineers, foster a culture of innovation, accountability, and continuous improvement
+ As needed, facilitate Agile ceremonies (planning, stand-ups, various, etc.) to drive team performance and deliver high-quality outcomes
+ As needed, collaborate with Product Owners, Customer Success, Architecture, stakeholders, and cross-functional teams to prioritize backlogs and align engineering efforts with business objectives
+ Work with team peers to manage the escalation process for critical incidents and solution outages related to End User Technologies, ensuring timely resolution and effective communication with stakeholders
+ Establish and refine incident management procedures, including root cause analysis and post-mortem reviews to prevent recurrence
+ Coordinate with support teams, vendors, and other IT functions to address complex technical issues and restore services efficiently
+ Use monitoring and reporting to identify, track and trend endpoint related performance issues impacting end users and DEX score
+ Identify opportunities to automate processes, reduce manual effort, document procedures, and increase the reliability of End User Technologies
+ Stay informed of industry trends, emerging technologies, and best practices to drive innovation within the DEX domain
+ Performs other duties as assigned
+ Complies with all policies and standards
**Education/Experience:**
A Bachelor's degree in a quantitative or business field (e.g., statistics, mathematics, engineering, computer science) and Requires 4 - 6 years of related experience.
Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
**Technical Skills:**
+ Experience with additional End User Technology solutions (e.g., Microsoft Endpoint Manager, ServiceNow, Cloud Computing, Group Policy, InTune, etc)
+ Proven track record of driving DEX improvements and measurable business outcomes
+ Hands-on experience with Nexthink or similar DEX platforms
+ Strong background in incident management, escalation handling, and service restoration for End User Technologies
+ Demonstrated expertise in Agile methodologies (e.g., Scrum, Kanban).
+ Ability to analyze complex problems and drive effective solutions in high-pressure situations
+ Strong analytical skills with experience using data to guide decision-making
**Soft Skills:**
+ Intermediate - Seeks to acquire knowledge in area of specialty
+ Intermediate - Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
+ Intermediate - Ability to work independently
+ Intermediate - Demonstrated analytical skills
+ Intermediate - Demonstrated project management skills
+ Intermediate - Demonstrates a high level of accuracy, even under pressure
+ Intermediate - Demonstrates excellent judgment and decision making skills
**License/Certification:**
+ Certifications in Agile (e.g., Scrum Master, Product Owner) or IT Service Management (e.g., ITIL) preferred
Pay Range: $87,000.00 - $161,300.00 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
$87k-161.3k yearly 14d ago
Field Care Coordinator - Richmond, VA
Unitedhealth Group 4.6
Richmond, VA job
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
This is a field-based position with a home-based office based in Richmond, VA Market. For consideration, you must reside within a commutable distance of Richmond, VA.
The Field Care Coordinator is responsible for facilitating, promoting, and advocating for the enrollees' ongoing self-sufficiency and independence. This position is responsible for assessment and planning for an identified group of patients. Additionally, the care coordinator is responsible for assessing the availability of natural supports such as the enrollee's representative or family members to ensure the ongoing mental and physical health of those natural supports. The Field Care Coordinator collaborates with the Interdisciplinary Team to coordinate the delivery of comprehensive, efficient, cost-effective patient care. The Field Care Coordinator will be traveling into enrollees' homes, nursing facilities, Adult Day Health, and Adult Living Facilities (ALF) to conduct in-depth assessments and develop the plan of care. The Field Care Coordinator actively assists enrollees with care transitions in collaboration with the Interdisciplinary Team and the acute or skilled facility staff, and the enrollees and / or the enrollees' representatives. Field Care Coordinators act as liaison between the Health Plan, the Commonwealth, enrollees, and their families. Field Care Coordinators follow established professional standards of care, Commonwealth guidelines and policy and procedures.
If you are located in commutable distance of Richmond, VA, you will have the flexibility to work remotely* as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Primary Responsibilities:
Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs
Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines
Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan
Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health
Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission
Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team
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:
Current and unrestricted Licensed Practical Nurse in the state of Virginia OR Social Work or Human Services (or related field) with a 4-year degree
3+ years of care coordination or behavioral health experience and/or work in a healthcare environment
1+ years of experience with MS Office, including Word, Excel, and Outlook
Experience working with members who have medical needs, the elderly, individuals with physical disabilities and / or those who may have communication barriers
Driver's license and reliable transportation and the ability to travel within assigned territory to meet with members and providers
Preferred Qualifications:
CCM certification
Experience working with Medicaid / Medicare population
Experience working in team-based care
Long term care / geriatric experience
Background in Managed Care
Physical Requirements:
Ability to transition from office to field locations multiple times per day
Ability to navigate multiple locations/terrains to visit employees, members and/or providers
Ability to transport equipment to and from field locations needed for visits (ex. laptop, stethoscope, etc.)
Ability to remain stationary for long periods of time to complete computer or tablet work duties
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
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 $23.89 to $42.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
#UHCPJ
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.
$23.9-42.7 hourly 3d ago
HSS Coordinator - Northern, VA Market
Unitedhealth Group 4.6
Richmond, VA job
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
This is a Field-Based role with a Home-Based office. You must reside within a commutable distance of Northern, VA for consideration.
Primary Responsibilities:
Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
Conduct initial and follow-up assessments within designated timeframes
Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
Manage the care plan throughout the continuum of care as a single point of contact
Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team
Provide subsequent member follow - up as determined by individual member needs
Liaison with other case managers and UM staff to help coordinate services and treatment
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 Social Work or Human Services
3+ years of experience working within the community health setting in a health care role
2+ years of behavioral health experience
1+ years of experience working with Medicaid population and working with GAP population
Intermediate skills with MS Word, Excel and Outlook
Willingness to travel (up to 25%) within a designated geographical region of Virginia for home/site visits
Access to reliable transportation
Preferred Qualifications:
Experience working with SMI or co-occurring disorders
Experience with electronic charting
Experience in long-term care, home health, hospice, public health or assisted living
Experience with arranging community resources
Field based work experience
A background in managing populations with complex medical or behavioral needs
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 $23.41 to $41.83 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.
$23.4-41.8 hourly 2d ago
Senior Digital Designer
Humana 4.8
Richmond, VA job
**Become a part of our caring community and help us put health first** The Senior Digital Designer responsible for creating, executing, developing, and maintaining digital design elements across multiple platforms. The Senior Digital Designer 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 Digital Designer collaborate closely with cross-functional teams to conceptualize, design, and produce digital content, graphics, animations, and user interfaces that align with organizational goals and enhance the user experience. Utilize common frameworks to build and develop interactive and responsive digital solutions that ensure compatibility, efficiency, and maximum value for the end-user. Support various business objectives, including product development, advertising, marketing, media, and communications. 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**
Typically requires Bachelor's degree or equivalent and 5+ years of technical experience
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$94,900 - $130,500 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 02-22-2026
**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 ***************************************************************************
$94.9k-130.5k yearly 7d ago
Medical Director - Nat'l IP UM Team
Humana 4.8
Richmond, VA job
**Become a part of our caring community and help us put health first** Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, level of care, and/or site of service should be authorized. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work.
The Medical Director's work includes reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services. They will have regular discussions with external providers by phone to gather additional clinical information and discuss determinations. Medical directors are expected to understand Humana processes with a focus on collaborative professional relationships. The ideal candidate will have a high degree of integrity, professionalism, resourcefulness, and enjoy working in a team-based environment. Medical Directors support Humana value throughout all activities.
**Responsibilities**
The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are concordant with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. After completion of structured and mentored training, daily work is performed with minimal direction, but with ready support from other team members. The ideal candidate enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations and meets compliance timelines.
+ Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services
+ Maintain accountability for productivity, quality, and compliance metrics
+ Communicate determinations clearly both verbally and in writing
+ Participate in rotational weekend work and occasional holiday responsibilities
+ Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices
**Work Schedule Monday - Friday w/standard weekends (about 5 per year on average) Eastern Time Zone hours**
**Use your skills to make an impact**
**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, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).
+ Current and ongoing Board Certification an approved ABMS Medical Specialty
+ 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 working in a team environment
+ **Work Schedule Monday - Friday w/standard weekends (about 5 per year on average) Eastern Time Zone hours**
**Preferred Qualifications**
+ Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, or other healthcare providers.
+ Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial health insurance.
+ Experience with national guidelines such as MCG or InterQual
+ Experience in hospital-based clinical practice, including specialties of Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, and hospital-based clinical specialists
+ The curiosity to learn and the flexibility to adapt to changes in order to enhance efficiency, productivity, and organizational goals.
+ Ability to thrive in a dynamic fast-paced, team-oriented environment.
+ Commitment to a culture of innovation, including being facile with using technology to improve workflows
+ Participate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contribution
+ Passionate about contributing to an organization's focus on consistency in outcomes, consumer experiences and a highly engaged team culture
**Additional Information**
The medical director reports to a Lead Medical Director.
Participation in weekend work on a rotational basis to ensure cases are decisioned in a timely manner
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: 04-30-2026
**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 60d+ ago
Scheduler Rep- FT- Mon to Fri- St Petersburg FL
Tenet 4.5
Petersburg, VA job
Conifer Patient Communications As a part of the Tenet and Catholic Health Initiatives family, Conifer Health Solutions is a leading healthcare business process management services provider working to improve operational performance for more than 600 clients so they can support financial improvement, enhance the patient experience, and drive value-based performance. Through our revenue cycle management, patient communications, and value-based care solutions, we empower healthcare decision makers-hospitals, health systems, physicians, self-insured employers, and payers-to better connect every point of care and wellness management. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Conifer Patient Communications is currently hiring for a full time Scheduler Representative at our Communications and Engagement center in St. Petersburg, Florida conveniently located in the Carillon Office Park. This position works Monday through Friday from either 10\:00am-6\:30pm or 10\:30am-7\:00pm. We offer a competitive salary, paid vacation and medical/dental/vision coverage from the 31st day of hire and 401(k) after 90 days. JOB SUMMARY Responsible for accurately scheduling diagnostic and/or surgical procedures. Conducts physician office/patient interviews, and explains hospital procedure guidelines and policies. Coordinates with clinical departments on schedule modifications.
JOIN OUR TEAM
QUALITY CARE DELIVERED BY COMPASSIONATE PEOPLE
We know it takes a special person to work in healthcare, and we are committed to providing our people with an enriching and rewarding environment. We deliver the resources, tools and support our employees need to serve our patients and customers in the best way possible - so we can create happier, healthier communities.
COMMITTED TO DIVERSITY AND INCLUSION
At Tenet, we believe in a diverse and inclusive environment, one that is grounded in our dedication to the health and well-being of all people. Respecting, nurturing and encouraging diversity of thought, background and experience contribute to positive work environments that result in exceptional patient care. We embrace diversity because it's our culture, and because it's the right thing to do.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Minimum typing skills of 35 wpm
Demonstrated working knowledge of software/system/equipment.
Knowledge of function and relationships within a hospital environment preferred
Advance Customer service skills and experience
Ability to work in a Call center environment
Ability to receive and express detailed information through oral and written communications
Course in Medical Terminology required
Advanced understanding in surgery procedure scheduling preferred
High achievement in productivity.
Builds and maintains collaborative relationships with both internal and external Clients that lead to more effective communication and a higher level of productivity and accuracy.
Identifies opportunities to improve patient relations and shorten the time it takes to handle scheduling processes.
This position requires high-level problem solving and analytical skills, technical accuracy, excellent communication skills and the highest ethical standards.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience required to perform the job.
High School Diploma or equivalent required
2-5 year administrative experience in medical facility, health insurance, or related area.
3+ years in Patient Access/Scheduling preferred.
Some college coursework is preferred
MWW
$38k-53k yearly est. Auto-Apply 60d+ ago
Primary Care Physician
Humana Inc. 4.8
Richmond, VA job
Become a part of our caring community and help us put health first The Primary Care Physician (PCP) works as a lead in our team-based care environment. We are a value based care provider focused on quality of care for the patients we serve. Our care team consists of Doctors, Advanced Practice professionals, Pharm D, Care Coach Nurses, Medical Assistants, Behavioral Health, Specialists, Quality Based Coders, Referral Coordinators and more. Our approach allows us to provide an unmatched experience for seniors. Our model is positioned to provide higher quality care and better outcomes for seniors by providing a concierge experience, multidisciplinary services, coordinated care supported by analytics and tools, and deep community relationships. This robust support allows our PCP to see fewer patients and spend more time with those they do.
Responsibilities:
* Evaluates and treats center patients in accordance with standards of care.
* Follows level of medical care and quality for patients and monitors care using available data and chart reviews.
* Assists in the coordination of patient services, including but not limited to specialty referrals, hospital and SNF coordination, durable medical equipment and home health care.
* Acts as an active participant and key source of medical expertise with the care team through daily huddles.
* Helps Regional Medical Director and Center Administrator in setting a tone of cooperation in practice by displaying a professional and approachable demeanor.
* Completes all medical record documentation in a timely manner working with a quality- based coder to optimize coding specificity.
* Follows policy and protocol defined by Clinical Leadership.
* Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues.
* Participates in potential growth opportunities for new or existing services within the Center.
* Participates in the local primary care "on-call" program of CenterWell as needed.
* Assures personal compliance with licensing, certification, and accrediting bodies.
* Spend 100% of your time clinically focused on direct patient care, inclusive of patient facing time and general administrative time (charting, meetings, etc.) as it relates to direct patient care.
Use your skills to make an impact
Required Qualifications:
* Current and unrestricted medical license or willing to obtain a medical licenses in state of practice; eligible and willing to obtain licenses in other states in the region of assignment, as required
* Graduate of accredited MD or DO program of accredited university
* Excellent verbal and written communication skills
* Demonstrate a high level of skill with interpersonal relationships and communications with colleagues/patients
* Fully engaged in the concept of "Integrated team based care" model
* Willingness and ability to learn/adapt to practice in a value based care setting
* Superior patient/customer service
* Basic computer skills, including email and EMR
* This role is considered patient facing and is a part of our Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
Preferred Qualifications:
* Board Certification or Eligible to become certified (ABMS or AOA) in Family Medicine, Internal Medicine or Geriatric Medicine preferred
* Active and unrestricted DEA license
* Medicare Provider Number
* Medicaid Provider Number
* Minimum of two to five years directly applicable experience preferred
* Experience managing Medicare Advantage panel of patients with understanding of Best Practice in coordinated care environment in a value based relationship environment
* Knowledge of Medicare guidelines and coverage
* Bilingual is a plus
* Knowledge of HEDIS quality indicators
Additional Information:
* Guaranteed base salary + annual bonus
* Excellent benefit package - health insurance effective on your first day of employment
* CME Allowance/Time
* Occurrence Based Malpractice Insurance
* Relocation and sign-on bonus options
* 401(k) with Employer Match
* Life Insurance/Disability
* Paid Time Off/Holidays
* Minimal Call
#physiciancareers
#LI-DG1
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$203,400 - $299,500 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Us
About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient's well-being.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
$203.4k-299.5k yearly 10d ago
Associate Actuary, SPA-Rx
Humana 4.8
Richmond, VA 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.
_This a remote nationwide position_
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.
**Use your skills to make an impact**
**Required Qualifications**
+ Bachelor's Degree
+ Associate of Society of Actuaries (ASA) designation
+ MAAA
+ Strong communication skills
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
**Preferred Qualifications**
+ Prior Part D experience
+ Strong SAS skills
+ Prior Databricks experience
**Our Hiring Process**
As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called Modern Hire. Modern Hire Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.
If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews
If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
**Alert:** Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from ******************** with instructions to add the information into the application at Humana's secure website.
**_Humana is more than an equal opportunity employer, Humana's dedication to promoting diversity, multiculturalism, and inclusion is at the heart of what we do in all of our Humana roles. Diversity is more than a commitment to us, it is the foundation of what we do. We are fully focused on diversity of race, gender, sexual orientation, religion, ethnicity, national origin and all of the other fascinating characteristics that make us each uniquely wonderful._**
\#LI-Remote
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$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: 01-29-2026
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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 Easy Apply 29d ago
Medical Assistant
Humana Inc. 4.8
Richmond, VA job
Become a part of our caring community and help us put health first The Medical Assistant 2 is the first point of contact for patient care. Responsible for administrative duties in addition to patient care. The Medical Assistant 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments.
The Medical Assistant 2 performs clinical duties such as discussing symptoms and gathering and inputting information into the electronic medical records system, taking vital signs, giving injections, performing diagnostic tests, collecting specimens, drawing blood, sterilizing and cleaning equipment, and maintaining examination rooms at an outpatient care site. Collaborates closely with Physicians and Nurses. Delivers direct patient care dependent on what active certification allows. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion.
Use your skills to make an impact
Required
* Successful completion of MA school/training program or a Certified/Registered Medical Assistant or 5+ years of experience and approval from Provider
* High school diploma or equivalent
* CPR Certified
* This role is considered patient facing and is part of the company's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
Preferred
* Certified or Registered - (Arizona, Indiana, & South Carolina candidates require Medical Assistant Certification or Registration)
* Phlebotomy experience• Medication/vaccine administration experience
* 1+ years MA experience
* Value Based Care experience including knowledge of HEDIS, CPT/ICD coding, and CAHPS/HOS Patient Experience.
* Bilingual proficiency in English and Spanish - must pass proficiency exam prior to foreign language communication
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.
$40,000 - $52,300 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Us
About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient's well-being.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
$40k-52.3k yearly 9d ago
Actuarial Principal - Financial Planning and Analysis
Humana 4.8
Richmond, VA job
**Become a part of our caring community and help us put health first** Join Humana's Financial Planning & Analysis team, part of the CFO team, which drives aggregate financial results and insights across primarily Individual Medicare Advantage (MA). This team serves as a central hub for financial strategy and analysis, with connections to enterprise-wide and total Insurance perspectives. The Actuarial Analytics/Forecasting Principal role offers flexibility in responsibilities, significant exposure to senior leadership, and strong potential for upward mobility.
We seek candidates who are willing to think creatively, challenge assumptions, voice opinions on key drivers and ranges, and contribute to a culture of continuous improvement and healthy debate.
The Actuarial Analytics/Forecasting Principal 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 Actuarial Analytics/Forecasting Principal provides strategic advice and guidance to functional team(s). Highly skilled with broad, advanced technical experience.
The Actuarial Analytics/Forecasting Principal 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. Works with senior executives to develop and drive segment or enterprise-wide functional strategies. Advises one or more areas, programs, or functions and provides recommendations to senior executives on matters of significance, and as an advanced subject matter expert competent to work at very high levels in multiple knowledge and functional areas across the enterprise.
**Use your skills to make an impact**
**Required Qualifications**
+ Bachelor's degree, in some instances a Master's or Doctorate's degree
+ 10 or more years of technical experience
+ 2-5 years of project/people leadership
+ FSA or ASA plus relevant advanced degree, recent and relevant work experience, and/or other relevant professional designations
+ MAAA
+ Strong communication skills
+ Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending)
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
**Preferred Qualifications**
+ Medicare Advantage pricing and forecasting experience
+ Experience working with aggregate financials across insurance products or enterprise-level financial planning
+ Demonstrated ability to challenge existing assumptions and propose creative solutions
**Additional Information**
Humana is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, or veteran status.
For more information on Humana careers, please visit Humana Careers (******************************* .
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$156,600 - $215,400 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 01-30-2026
**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 ***************************************************************************
$156.6k-215.4k yearly 37d ago
Utilization Management Appeals Nurse
Humana 4.8
Richmond, VA job
**Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The Nurse reviews the medical documentation, researching claims, benefits, as well as prior determinations pertinent to the appeal and provides a written summary of findings using a template for each case. The associate will be working and collaborating with Humana CIT teams, Vendors, G&A specialists, and Humana Medical Directors on submitted G&A cases. The G&A Nurse will participate in initiatives which result in improved member outcomes, operational efficiencies, and process improvement opportunities.
+ Case preparation of Medicare and/or Duals line of businessinvolving expedited, pre-service and post serviceappeals
+ Apply and implement Medicare, Medicaid,MCG, claims policy and evidence of coverage guidelines for reviews
+ Perform outreach to providers and/or members
+ Utilize multiple systems such as MHK, CGX, MRM, SRO
**Use your skills to make an impact**
**Required Qualifications**
+ Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action
+ 3 or more years of clinical experience preferably in an acute care, skilled or rehabilitation clinical setting or broad clinical nursing experience
+ Comprehensive knowledge of Microsoft Word, Outlook and Excel
+ Strong organizational and effective time management skills
+ Ability to work independently under general instructions and with a team
**Preferred Qualifications**
+ Bachelor's degree (BSN)
+ Appeal Review Experience
+ Knowledge of MHK
+ Previous Medicare/Medicaid Experience
+ Previous experience in utilization management
+ Previous claims experience
**Work-At-Home Requirements**
To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
+ 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
**Additional Information**
+ Hours are Monday-Friday 9am-6pm EST with a weekend rotation (Your 8-hour shift will fall within this timeframe)
+ Candidate's must also commit to working on the holidays as needed
+ This is a remote position, but all candidates must work in the Eastern Standard Time Zone (EST)
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.
$71,100 - $97,800 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: 01-21-2026
**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 ***************************************************************************
$71.1k-97.8k yearly 5d ago
Business Intelligence Lead - Digital VOC
Humana 4.8
Richmond, VA job
**Become a part of our caring community and help us put health first** The Digital Voice of Customer (VoC) Program Leader & Insights Champion will own and advance the end-to-end VoC strategy across Digital CW, ensuring measurement approaches align with customer experience goals and business priorities. This position is responsible for vendor management (Qualtrics), cross-functional stakeholder collaboration, and driving everyday self-service and adoption of VoC insights throughout the organization. The ideal candidate will develop diverse VoC touchpoints, analyze structured and unstructured data, present findings through effective storytelling, and serve as a thought leader to educate and empower teams for data-driven decision-making.
**Key Responsibilities** :
+ Develop, execute, and continuously refine the comprehensive VoC Program strategy for Digital CW, ensuring alignment with enterprise customer experience objectives and business priorities.
+ Manage and cultivate the vendor relationship with Qualtrics, representing the interests of Digital CW and collaborating with the Humana Digital lead.
+ Partner with stakeholders across UX, Product, Business Intelligence, Operations, and other lines of business to strategize, design, and implement optimal VoC touchpoints-including expansion beyond digital channels-to capture actionable customer insights.
+ Champion the incorporation of VoC metrics into everyday business practices, fostering a pull-driven, self-service engagement model across the enterprise.
+ Analyze structured and unstructured data to identify trends, friction points, opportunities for improvement, and root causes impacting user experiences.
+ Synthesize and communicate insights through compelling storytelling to influence cross-functional teams and drive user-backed optimizations.
+ Stay current with industry trends, emerging tools, and best practices to enhance VoC program effectiveness and operational efficiency.
+ Serve as a thought leader, educating stakeholders and promoting a culture of data-driven decision-making.
**Use your skills to make an impact**
**Required Qualifications**
+ Bachelor's degree and 8 or more years of technical experience in data analysis OR Master's degree and 4 years of experience
+ 2 or more years of project leadership experience
**Preferred Qualifications**
+ Demonstrated experience leading VOC or customer experience programs in a digital environment
+ Strong vendor management skills, preferably with Qualtrics or similar platforms
+ Knowledge of current trends and tools in customer experience measurement and analytics
+ Advanced experience in analysis and synthesis of quantitative and qualitative data
+ Excellent communication, presentation, and storytelling skills to inform and influence senior and executive leadership
+ Experience aggregating data across multiple sources (e.g., primary research, secondary research, operational data)
+ Working knowledge of primary research techniques (e.g., basic survey design)
+ Advanced Degree in a quantitative discipline, such as **Business, Marketing, Analytics** , Mathematics, Statistics, Computer Science, or related field
+ Passion for contributing to an organization focused on continuously improving consumer experiences
+ Experience analyzing data to solve a wide variety of business problems and create data visualizations that drive strategic direction
+ Advanced experience working with big and complex data sets within large organizations
+ Proven ability to work with cross-functional teams and translate requirements between business, project management and technical projects or programs
+ Proficiency in understanding Healthcare related data
+ Experience creating analytics solutions for various healthcare sectors
+ Advanced in SQL, SAS and other data systems
+ Experience with tools such as Tableau and Qlik for creating data visualizations
+ Expertise in data mining, forecasting, simulation, and/or predictive modeling
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.
$117,600 - $161,700 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: 04-17-2026
**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 ***************************************************************************
$117.6k-161.7k yearly 6d ago
Community Health Worker
Humana 4.8
Richmond, VA job
**Become a part of our caring community and help us put health first** Must reside in Tidewater Region- Va. Beach, Norfolk, Chesapeake, Portsmouth. Humana Healthy Horizons in Virginia is looking for Community Health Workers to contribute to the administration of care management. They provide non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Community Health Worker's work assignments are often straightforward and of moderate complexity.
Community Health Workers (CHW) serves as members of our Medicaid enrollee centric Comprehensive Care Support teams. The CHW applies a hands-on approach to enrollee engagement to support case management functions, address health related social needs (HRSN) to improve self-management of chronic conditions, navigate the healthcare system, and promote prevention and health education that is tailored to the needs of the communities we serve. The CHW leverages their knowledge of the community and shared life experience to inform their interactions with enrollees and Humana's community partners.
+ Works collaboratively with other Humana associates as a member of Humana's Comprehensive Care Support team, including case managers, housing specialists, and HRSN coordinators.
+ Conducts in-person assessment(s) to understand member care needs, preferences, and socioeconomic barriers and evaluate the home environment.
+ Assesses member barriers to healthy living and accessing healthcare services and assist enrollees with scheduling physical health and behavioral health (BH) office visits, addressing barriers to appointment attendance.
+ Acts as a member advocate with providers, community resources, schools, and others, including accompanying members to provider office visits as requested.
+ Assists member with navigating health care and social service systems and coordinate access to basic needs (e.g. housing, food, income, transportation).
+ Promotes and monitors member adherence with their care plan and provide motivational interviewing to support medication and treatment adherence.
+ Provides social support to help boost member's morale and sense of self-worth, serving as a trustworthy, reliable, non-judgmental, consistent, and accepting member of the member's multi-disciplinary team.
+ Supports member self-management through the provision of culturally appropriate health education and health coaching.
+ Attends Humana community events to connect with members and provide education on case management services.
+ Conducts research and in-person outreach to locate difficult-to-contact members to increase assessment completion and participation in clinical programs.
+ May assist with Health Risk Screenings (MMHS).
+ Builds and maintains relationships with providers and community resources to support member referrals and implement community assessments to identify community resource gaps.
+ Supports the implementation of Humana's Readmission Prevention and ED Diversion program.
**Use your skills to make an impact**
**Required Qualifications**
+ **Must reside in the Tidewater Region of the Commonwealth of Virginia in the counties/independent cities of:** **_Virginia Beach, Norfolk, Chesapeake and Portsmouth_**
+ Minimum two (2) years prior experience working with community resources, community health agencies/social service agencies (Area Agency on Aging, DME providers, Meals on Wheels etc.).
+ Intermediate working knowledge using Microsoft Office Programs specifically Teams, Excel, PowerPoint, Outlook and Word.
+ Exceptional communication & interpersonal skills with the ability to build rapport with internal and external customers and stakeholders.
+ Decision making skills regarding own work approach/priorities, and work assignments, standards and resources.
+ Ability to multi-task and work in a very fast-paced environment.
+ Strong understanding and respect of all cultures and demographic diversity.
+ Strong written communication skills and a strong advocate for members at all levels of care.
+ This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
+ Ability to travel to region-based facilities and homes for face-to-face assessments and interactions with members and/or families.
+ This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.
**Preferred Qualifications**
+ An active unrestricted LPN (Licensed Practical Nurse) license in the Commonwealth of Virginia.
+ Bachelor's degree in social work or a related field.
+ Community Health Worker training and/or certificate or willingness to complete within one (1) year.
+ Familiarity with state Medicaid program guidelines.
+ Experience engaging with Medicaid enrollees, including those with physical health and behavioral health needs and varied health literacy.
+ Bilingual or Multilingual: English/Spanish, Arabic, Vietnamese, Amharic, Urdu or other - Must be able to speak, read and write in both languages without limitations and assistance. See "Additional Information" for more information.
**Additional information**
+ **Workstyle:** Field - This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes.
+ **Travel:** 50 - 75% field interactions with members, and their families and providers. May need to attend onsite meetings occasionally in Humana Healthy Horizons office in Glen Allen, VA.
+ **Workdays and Hours:** Monday - Friday; 8:00am - 5:00pm Eastern Standard Time (EST).
+ **Language Assessment Statement:** 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.
**WAH Internet Statement**
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Humana will provide Home or Hybrid Home/Office employees 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.
**Interview Format**
As part of our hiring process for this opportunity, we will be using an 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.
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.
$41,900 - $56,600 per year
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
**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 ***************************************************************************
$41.9k-56.6k yearly 8d ago
2026 Actuarial Development Program Analyst
Genworth Financial 4.4
Richmond, VA job
At Genworth, we empower families to navigate the aging journey with confidence. We are compassionate, experienced allies for those navigating care with guidance, products, and services that meet families where they are. Further, we are the spouses, children, siblings, friends, and neighbors of those that need care-and we bring those experiences with us to work in serving our millions of policyholders each day.
We apply that same compassion and empathy as we work with each other and our local communities. Genworth values all perspectives, characteristics, and experiences so that employees can bring their full, authentic selves to work to help each other and our company succeed. We celebrate our diversity and understand that being intentional about inclusion is the only way to create a sense of belonging for all associates. We also invest in the vitality of our local communities through grants from the Genworth Foundation, event sponsorships, and employee volunteerism.
Our four values guide our strategy, our decisions, and our interactions:
* Make it human. We care about the people that make up our customers, colleagues, and communities.
* Make it about others. We do what's best for our customers and collaborate to drive progress.
* Make it happen. We work with intention toward a common purpose and forge ways forward together.
* Make it better. We create fulfilling purpose-driven careers by learning from the world and each other.
POSITION TITLE
Actuarial Development Program Analyst - 2026
POSITION LOCATION
This position is hybrid and located in Richmond, VA. Candidates may be eligible for relocation assistance if they are not located in the area.
YOUR ROLE
Genworth's innovative Actuarial Development Program aids in the navigation from aspiring to accomplished actuary through obtaining the esteemed FSA designation. Beginning Summer 2026, this multiple year program consists of 18-30 month rotational assignments that allow you to build foundational skills and competencies, business acumen, and leadership. Rotations will be within our various product lines and functions, providing you with diverse experiences and exposure throughout the organization.
Genworth fully supports our Actuarial Development Program members as they progress in their actuarial education. You will have study time available during work hours - up to 200 hours in any six-month period. Genworth will cover fees associated with exams, including registrations, study materials, and seminars. You will also receive salary increases for each exam passed with an extra bonus for passing on your first attempt.
What you will be doing
As a member of the Genworth's Actuarial Development Program, you can expect to:
* Work in a fast-paced, innovative, and change-oriented work environment
* Build a strong network of peers and mentors
* Attend on-site technical and professional development classes
* Participate in sponsored community service events
* Utilize advanced Excel techniques and programming
* Work with large data sets
* Gain exposure to actuarial software, including GGY AXIS, MG-ALFA, and PolySystems
What you bring
* Must be graduating by the Spring of 2026 with a Bachelor's or Master's degree in Actuarial Science, Statistics or Mathematics related field of study
* At least one passed Society of Actuaries (SOA) Exam
* Minimum final grade point average of 3.2 on a 4.0 scale
* Career aspirations to attain a Fellowship designation.
* Demonstrated math and analytical skills
* Previous internship experience, preferably within the insurance industry
* Participation in some team or individual case study projects during undergraduate program
* Demonstrated proficiency in oral and written communications
Employee Benefits & Well-Being
Genworth employees make a difference in people's lives every day. We're committed to making a difference in our employees' lives.
* Competitive Compensation & Total Rewards Incentives
* Comprehensive Healthcare Coverage
* Multiple 401(k) Savings Plan Options
* Auto Enrollment in Employer-Directed Retirement Account Feature (100% employer-funded!)
* Generous Paid Time Off - Including 12 Paid Holidays, Volunteer Time Off and Paid Family Leave
* Disability, Life, and Long Term Care Insurance
* Tuition Reimbursement, Student Loan Repayment and Training & Certification Support
* Wellness support including gym membership reimbursement and Employee Assistance Program resources (work/life support, financial & legal management)
* Caregiver and Mental Health Support Services
ADDITIONAL
* At this time, Genworth will not sponsor a new applicant for employment authorization for this position.
$63k-84k yearly est. Auto-Apply 37d ago
Senior IT Product Manager - Information Marketplace & Data Governance Platform
Humana 4.8
Richmond, VA job
**Become a part of our caring community and help us put health first** The Senior IT Product Manager - Information Marketplace & Data Governance is responsible for the strategic vision, roadmap, and execution of the Information Marketplace and its ecosystem of integrated enterprise capabilities. This role owns the end-to-end product lifecycle for the Information Marketplace as well as integrations with its supporting capabilities, data discovery, data quality and observability, metadata management, data cataloging, semantic enablement, and governed data usage processes such as the Protected Information Review Council (PIRC).
The Information Marketplace serves as the front door and starting off point for finding and understanding Humana's data. It serves a large role in day-to-day data usage and management processes and that role will continue to expand and evolve.
The Senior IT Product Manager partners closely with data governance leadership, architecture, engineering, security, compliance, and business stakeholders to ensure these capabilities operate as a cohesive, scalable product that enables trusted data use, risk reduction, and business value realization. They will create, prioritize and manage product backlogs with a focus on iteration and scalability. They will directly influence department strategy and make decisions on moderately complex to complex issues regarding technical and non-technical approaches for project components. Work will be performed without direction and considerable latitude will need to be exercised in determining objectives and approaches.
Detailed Responsibilities
**Product Strategy & Vision**
+ Define and own the long-term product vision and roadmap for the Information Marketplace and its integration to supporting capabilities and processes.
+ Translate enterprise data governance, compliance, and analytics strategies into actionable product capabilities and prioritized initiatives.
+ Act as the product authority for how data discovery, quality, observability, metadata management, and semantic layers work together as a unified experience.
**Information Marketplace Ownership**
+ Own the Information Marketplace as a core enterprise product, including user experience, adoption, scalability, and extensibility.
+ Ensure the Marketplace enables intuitive discovery of curated and un-curated data assets.
+ Drive continuous improvement of Marketplace capabilities based on usage analytics, stakeholder feedback, and emerging governance trends.
**Platform Integrations & Ecosystem Management**
+ Lead integration strategy and execution across platforms supporting:
+ Data quality and observability
+ Data cataloging and metadata management
+ Data lineage and impact analysis
+ Semantic layers and business term enablement
+ Workflow and approval processes (e.g., PIRC)
+ Partner with architecture and engineering teams to ensure integrations are scalable, secure, resilient, and aligned with enterprise standards.
+ Manage dependencies across internal platforms, vendor tools, and custom-built solutions.
**Stakeholder Engagement & Leadership**
+ Serve as the primary product interface between data governance leadership and stakeholders.
+ Facilitate prioritization decisions.
+ Communicate product strategy, roadmap progress, and outcomes to executive and senior leadership audiences.
**Delivery & Execution**
+ Own and manage the product backlog, ensuring clear articulation of epics, features, and acceptance criteria.
+ Partner with agile delivery teams to ensure timely, high-quality execution of product initiatives.
+ Define and track success metrics related to adoption, data trust, operational efficiency, and risk reduction.
**Use your skills to make an impact**
**Required Qualifications**
+ 8+ years of experience in product management, technology product ownership, or platform leadership roles.
+ Proven experience managing complex, enterprise-scale platforms with multiple integrations and stakeholders.
+ Demonstrated success owning products across the full lifecycle, from strategy and vision through delivery and adoption.
+ Ability to work effectively with architects and engineers on integration patterns, APIs, metadata flows, and platform interoperability.
+ Experience operating in hybrid or multi-platform environments, including vendor tools and custom-built solutions.
+ Exceptional stakeholder management skills, with the ability to influence without direct authority.
**Preferred Qualifications**
+ Strong understanding of data governance concepts, including metadata management, data quality, data lineage, and data stewardship.
+ Experience with data discovery, data cataloging, or information marketplace-style platforms.
+ Familiarity with compliance-driven data usage processes (e.g., privacy reviews, data access approvals, risk assessments).
+ Strong understanding of how semantic layers, business glossaries, and metadata drive analytics and AI enablement.
+ Strong executive communication skills, including the ability to translate complex technical concepts into business outcomes.
+ Experience supporting regulated industries (e.g., healthcare, financial services, insurance).
+ Exposure to data observability platforms, data quality automation, or AI-enabled governance capabilities.
+ Experience operationalizing governance processes through workflow tools or custom platforms.
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.
$104,000 - $143,000 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: 03-26-2026
**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 ***************************************************************************
$104k-143k yearly 7d ago
Genworth IT Development Program Intern - Summer 2026
Genworth Financial 4.4
Richmond, VA job
At Genworth, we empower families to navigate the aging journey with confidence. We are compassionate, experienced allies for those navigating care with guidance, products, and services that meet families where they are. Further, we are the spouses, children, siblings, friends, and neighbors of those that need care-and we bring those experiences with us to work in serving our millions of policyholders each day.
We apply that same compassion and empathy as we work with each other and our local communities. Genworth values all perspectives, characteristics, and experiences so that employees can bring their full, authentic selves to work to help each other and our company succeed. We celebrate our diversity and understand that being intentional about inclusion is the only way to create a sense of belonging for all associates. We also invest in the vitality of our local communities through grants from the Genworth Foundation, event sponsorships, and employee volunteerism.
Our four values guide our strategy, our decisions, and our interactions:
* Make it human. We care about the people that make up our customers, colleagues, and communities.
* Make it about others. We do what's best for our customers and collaborate to drive progress.
* Make it happen. We work with intention toward a common purpose and forge ways forward together.
* Make it better. We create fulfilling purpose-driven careers by learning from the world and each other.
POSITION TITLE
IT Development Program Intern - Summer 2026
POSITION LOCATION
This hybrid position is located in Richmond, Virginia.
YOUR ROLE
You are future-focused, continuously branching out and finding innovative solutions to difficult problems. At Genworth, we will welcome your technical skills and innovative perspective as an IT Intern. Beginning Summer 2026, Genworth's 10-to-12 week internship provides students with valuable experience needed for a successful beginning to any IT career. Our interns will work with top IT Leaders to solve real-world problems because our financial services and products touch real lives-whether we're providing support for caregivers, enabling independent living, or connecting our customers with high quality care resources. At the end of the summer, successful interns who are rising seniors may interview and apply for a position in the full-time IT Development Program (ITDP).
What you will be doing
* Working in a fast-paced, innovative, and change-oriented work environment
* Assignments will be to teams in core IT processes in Application Development, IT Infrastructure, Security, Automation, System Integration, Cloud Engineering, Data Science, and/or Project Management.
* Building a strong network of peers and mentors
* Attending on-site technical and professional development classes
* Presenting accomplishments to IT teams and senior leadership
* Participating in sponsored community service events
Must Have/What you bring
* Pursuing a Bachelor Degree's in Computer Science, Engineering (Computer, Systems, Electrical), Computer/Management Information Systems, or Math
* Academic excellence
* Strong analytical ability and communication skills
* Proven leadership and interpersonal skills
Nice To Have
* Minimum grade point average of 3.2 on a 4.0 scale
* Understanding of business concepts/strategy
* Multiple programming language skills
Why Work at Genworth
* We have a real impact on the lives of the people we serve
* We work on challenging and rewarding projects
* We give back to the communities where we live • We have a real impact on the lives of the people we serve
* We work on challenging and rewarding projects
* We give back to the communities where we live
ADDITIONAL
* At this time, Genworth will not sponsor a new applicant for employment authorization for this position.
$30k-41k yearly est. Auto-Apply 37d ago
Accountant, Accounting Controls and Reporting Team
Genworth 4.4
Richmond, VA job
At Genworth, we empower families to navigate the aging journey with confidence. We are compassionate, experienced allies for those navigating care with guidance, products, and services that meet families where they are. Further, we are the spouses, children, siblings, friends, and neighbors of those that need care-and we bring those experiences with us to work in serving our millions of policyholders each day.
We apply that same compassion and empathy as we work with each other and our local communities. Genworth values all perspectives, characteristics, and experiences so that employees can bring their full, authentic selves to work to help each other and our company succeed. We celebrate our diversity and understand that being intentional about inclusion is the only way to create a sense of belonging for all associates. We also invest in the vitality of our local communities through grants from the Genworth Foundation, event sponsorships, and employee volunteerism.
Our four values guide our strategy, our decisions, and our interactions:
Make it human. We care about the people that make up our customers, colleagues, and communities.
Make it about others. We do what's best for our customers and collaborate to drive progress.
Make it happen. We work with intention toward a common purpose and forge ways forward together.
Make it better. We create fulfilling purpose-driven careers by learning from the world and each other.
POSITION TITLE
Accountant, Accounting Controls & Reporting Team
POSITION LOCATION
Richmond, VA (hybrid)
YOUR ROLE
Reporting to the Senior Accounting Manager, Corporate Finance, you will lead the execution of the Company's consolidation process, account for capital transactions and perform variance analysis to support external reporting.
What you will be doing
Conduct the Company's consolidation process supported by the Company's general ledger; including but not limited to:
Execution of consolidation accounting, including operational compliance
Accounting for various transactions, ensuring complete and accurate record keeping while maintaining the integrity and control of our book of record, the general ledger
Collaborating with cross-functional teams including corporate and business controllership, tax and investments, technical accounting and IT to properly recognize equity transactions including but not limited to sales/deconsolidations, share buybacks and resegmentations
Troubleshooting general ledger inquiries, such as how to record transactions related to consolidations and equity transactions while maintaining procedures and controls
Collaborating with IT on matters impacting the Company's general ledger and control environment
Support the SEC reporting process through variance analysis and reporting to senior leadership
Engage in a high performing team that focuses principally on:
The monthly/quarterly close process, ensuring targets are adhered to and efficiencies are gained
The account reconciliation process to safeguard the integrity of our significant accounts that support our financial records and controls
Supporting internal and external audit activities and inquiries
Preparing Government Reports quarterly and annually
Participate in cross training initiatives as well as the documentation of specific tasks as needed.
Support special projects as necessary
What you bring
Bachelor's Degree in Accounting or Finance
3+ years of relevant experience
General understanding of GAAP with the ability to apply accounting theory to accounting practice.
Knowledge of consolidation accounting - Preferred
Expertise in general ledger systems (Oracle preferred)
Proficiency in data analysis that supports compiling impactful analytics and presentations
Strong organization and critical thinking skills
Strong attention to detail and time conscious
Ability to multitask and prioritize to meet deadlines
Strong commitment to quality and productivity
Strong oral and written communication skills
Proficient computer skills, including an ability to leverage software packages
Puts team and team culture ahead of personal achievements
Ability to work effectively in a culturally diverse group with cross functional teams
Ability to proactively identify potential challenges and offer solutions
Ability to adapt to a rapidly changing environment
NICE TO HAVE
Insurance or financial services accounting experience at a large multinational public company
CPA (or equivalent) designation and/or an advanced degree
Employee Benefits & Well-Being
Genworth employees make a difference in people's lives every day. We're committed to making a difference in our employees' lives.
Competitive Compensation & Total Rewards Incentives
Comprehensive Healthcare Coverage
Multiple 401(k) Savings Plan Options
Auto Enrollment in Employer-Directed Retirement Account Feature (100% employer-funded!)
Generous Paid Time Off - Including 12 Paid Holidays, Volunteer Time Off and Paid Family Leave
Disability, Life, and Long Term Care Insurance
Tuition Reimbursement, Student Loan Repayment and Training & Certification Support
Wellness support including gym membership reimbursement and Employee Assistance Program resources (work/life support, financial & legal management)
Caregiver and Mental Health Support Services
ADDITIONAL
At this time, Genworth will not sponsor a new applicant for employment authorization for this position.
No agencies please
$87k-117k yearly est. 4d ago
Clinical Preceptor
Humana Inc. 4.8
Richmond, VA job
Become a part of our caring community and help us put health first The Learning Facilitation Professional 1 conducts or facilitates training courses for organization employees or external audiences. The Learning Facilitation Professional 1 work assignments are often straightforward and of moderate complexity.
The Learning Facilitation Professional 1 plans, coordinates, and implements all aspects of training programs for participants throughout the organization, including but not limited to instructor-led and virtual instructor-led training. Selects appropriate materials. Creates an environment that is conducive to learning and exchanging information, engages the learner, and produces the desired outcomes. Monitors training personnel records to ensure that employees have met all company training requirements for company, quality, and regulatory compliance. Analyzes course evaluations in order to judge effectiveness of training sessions and to implement suggestions for improvements. Evaluates the relevance of online resources to complement the facilitated experience in the fields as appropriate. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.
Use your skills to make an impact
Required Qualifications
* Bachelor's degree
* Less than 3 years of training or learning development experience
* Proficiency in Microsoft Office applications including Outlook, PowerPoint, Microsoft Project
* Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
* Experience using a wide variety of training tools to effectively facilitate to a wide audience.
* Experience managing projects or processes
Additional Information
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.
$48,900 - $66,200 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About Us
About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient's well-being.
About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
$48.9k-66.2k yearly 49d ago
Informaticist
Humana 4.8
Richmond, VA job
**Become a part of our caring community and help us put health first** The Provider Analytics organization's vision is to improve member healthcare through innovative analytics and actionable insights, which empower members, and providers to drive higher quality, lower cost of care, and improved health outcomes. Provider Analytics develops and applies actionable analytics and insights, which are integral to business needs, to drive informed provider network strategy and is looking for an Informaticist 2 to join their team.
The Informaticist 2:
+ Designs and constructs models to estimate impact of contractual changes tied to ancillary and industry leading innovative care delivery models
+ Collates, models, interprets and analyzes data in order to identify, explain, and influence variances and trends
+ Explains variances and trends and enhances modeling techniques
+ Utilizes multiple data sources such as SQL, Power BI, Excel, etc., to create advanced analytics to facilitate contracting initiatives
+ Uses a consultative approach to collaborate effectively with the markets, and other customers, building productive cross-functional relationships
+ Extracts historical data, performs data mining, develops insights to drive provider contracting strategy and reimbursement terms for National Ancillary Contracting
+ Develops tools and automates processes to model financial implications of ancillary contracted rate changes, including changes in capitated arrangements
In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include:
+ Medical Benefits
+ Dental Benefits
+ Vision Benefits
+ Health Savings Accounts
+ Flex Spending Accounts
+ Life Insurance
+ 401(k)
+ PTO including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time
+ And more
**Use your skills to make an impact**
**Required Qualifications**
+ 3+ years of demonstrated healthcare analytical experience
+ 1+ years SQL experience
+ 1+ years' experience in data visualization (ie. Power BI, Tableau, etc.)
+ Experience in compiling, modeling, interpreting and analyzing data in order to identify, explain, influence variances and trends
+ Experience in managing data to support and influence decisions on day-to-day operations, strategic planning and specific business performance issues
+ Possess a working knowledge and understand department, segment and organizational strategy
**Preferred Qualifications**
+ Bachelor's Degree in analytics or related field
+ Advanced Degree
+ Understanding of healthcare membership, claims, and other data sources used to evaluate cost and other key financial and quality metrics
**Additional Information**
Work at Home/Remote Requirements
**Work-At-Home Requirements**
+ To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate.
+ Wireless, Wired Cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.)
+ Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. 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
**Our Hiring Process**
As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging, and/or Video Interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone or computer. You should anticipate this interview to take approximately 10-15 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
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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.
$73,400 - $100,100 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: 01-21-2026
**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 ***************************************************************************