Become a part of our caring community and help us put health first The Director, Revenue Cycle Management for Humana Pharmacy will own the billing, collections and reporting for CenterWell Pharmacy & Specialty pharmacy and Humana Pharmacy Solutions, Humana's captive PBM.
This role will lead a large workforce across multiple geographies to maximize our billing while also ensuring to meet our patient, pharmaceutical clients and PBM partner needs. Within CenterWell Pharmacy, we continue to lead the industry with new product launches, including our Direct to Consumer and Direct to Employer offerings. This leader will be nimble and change oriented to meet the evolving market needs. This position may involve some financial budgeting as well as making decisions related to implementation of new/updated programs or large-scale projects to help support the strategic goals of the pharmacies. Additionally, the candidate will have the following key responsibilities:
Own the reconciliation of billing with the GL with partnership with controllership team
Provide comprehensive decision-making across the enterprise as it comes to revenue accounting
Develop and maintain team performance across our BPO partner and internal associates
Monitor performance by comparing and analyzing actual results with plans and forecasts
Improve financial status by analyzing results and variances, identifying trends, and recommending actions
Use your skills to make an impact
Required Qualifications
Bachelor's degree in finance, accounting or related field
8 or more years of revenue cycle management
5 or more years of management experience
Experience advising senior leadership on billing/collections strategies
Knowledge of pharmacy revenue cycle management
Prior experience developing methods and criteria for revenue cycle management
Exceptional communication and presentation skills, with the ability to influence and engage diverse audiences
Ability to lead and manage special projects that may necessitate cross-functional partnerships
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
Prior health insurance industry experience working in revenue cycle management
Pharmacy pricing knowledge or experience
Additional 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.
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. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA 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.
$126,300 - $173,700 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
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.
$37k-49k yearly est. 21h ago
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Senior Coding Educator
Humana 4.8
Humana job in Columbus, OH or remote
**Become a part of our caring community and help us put health first** The Senior Coding Educator identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. The Senior Coding Educator is responsible for creating and executing the risk adjustment strategy for each provider groups.
+ Analyzes data and reporting and provides educational sessions with providers aimed at quality of care, documentation and coding improvements.
+ Collaboration with relationship owners and HQRI
+ Research data and workflow processes and arranges educational sessions with providers aimed at quality of care and documentation improvements.
+ Monitor and develops strategy with Coding educator and leader, tailor's provider group webinars and discussions based on various Risk Adjustment topics.
**Use your skills to make an impact**
**Required Qualifications**
+ AAPC CPC (Certified Professional Coder) Certification
+ 2 or more years of medical record review knowledge
+ 2 or more years of risk adjustment provider education
+ Familiar with coding guidelines (i.e. ICD-9/ICD-10)
+ Comprehensive knowledge of MS Word, Excel and PowerPoint
+ Analyzing Data to drive process improvement
+ Experience with public speaking and presentation skills
**Preferred Qualifications**
+ Bachelor's degree
+ Certified Risk Coder (CRC)
+ Experience interacting with healthcare providers
+ Ability to work independently
+ Medicare Risk Adjustment knowledge
+ Analyzing data to build unique education strategies in PowerBi
**Additional Information**
**Department Hours: 7am to 5pm EST**
Work at home - with ability to travel (up to 25% to surrounding provider offices)
**Additional Information**
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 Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 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.
**Work at Home Guidance**
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
Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
\#LI-BB1
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.
**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 10d ago
Gastroenterologist Opening with Private Group in Mentor, Ohio
Tenet Healthcare 4.5
Mentor, OH job
OneGI is seeking a BC/ BE Gastroenterologist in Mentor, Ohio. A terrific opportunity to join an outpatient practice that provides world-class care!
Highlights:
General GI Practice; only 1 office location!
APP support
Infusion, Pathology, Imaging, Research, Anesthesia, Hem Banding available support services
1 ASC location with ownership potential
2-year practice partnership track
Benefits:
Competitive Base Salary with Competitive Production Earnings
Sign On Bonus and Moving Expenses
Medical, Dental, Vision, 401k Match
Malpractice Insurance
At One GI , we provide exceptional gastroenterology care that puts patients at the forefront. Since our inception in 2020, we have grown rapidly while remaining steadfast in our commitment to driving excellence and upholding the highest standards in gastroenterology practice. Our renowned physician leadership, collaborative team culture, state-of-the-art ancillary services, and robust network strength empower our physicians to deliver personalized, compassionate care tailored to each patient's unique needs.
One GI is more than just an organization; it's a community of over 1,300 dedicated individuals united by a shared purpose: creating a better healthcare experience for patients, colleagues, and communities. We are a diverse team of professionals who bring our unique perspectives and expertise to the table, fostering an environment of collaboration and continuous improvement. Each One GI practice is the leading provider of gastroenterology care in its respective community, retaining its regional name and unique reputation while leveraging the expansive resources and backing of our national organization.
Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status.
$157k-236k yearly est. 5d ago
Gastroenterology Opening with Private Group in Canton, Ohio
Tenet Healthcare 4.5
Canton, OH job
OneGI is seeking a BC/ BE Gastroenterologist to join an established practice in Canton, Ohio. A patient-centric group providing world-class care!
Highlights:
General GI Practice w/ APP support
Pathology, Research, Imaging, Anesthesia support services
Strong relationship with community hospital
1 ASC location with ownership potential
2-year practice partnership track
Benefits:
Competitive Base Salary with Competitive Production Earnings
Sign On Bonus and Moving Expenses
Medical, Dental, Vision, 401k Match
Malpractice Insurance
At One GI , we provide exceptional gastroenterology care that puts patients at the forefront. Since our inception in 2020, we have grown rapidly while remaining steadfast in our commitment to driving excellence and upholding the highest standards in gastroenterology practice. Our renowned physician leadership, collaborative team culture, state-of-the-art ancillary services, and robust network strength empower our physicians to deliver personalized, compassionate care tailored to each patient's unique needs.
One GI is more than just an organization; it's a community of over 1,300 dedicated individuals united by a shared purpose: creating a better healthcare experience for patients, colleagues, and communities. We are a diverse team of professionals who bring our unique perspectives and expertise to the table, fostering an environment of collaboration and continuous improvement. Each One GI practice is the leading provider of gastroenterology care in its respective community, retaining its regional name and unique reputation while leveraging the expansive resources and backing of our national organization.
Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status.
$29k-33k yearly est. 5d ago
Gastroenterology 100% Outpatient Practice in Brunswick, Ohio
Tenet Healthcare 4.5
Brunswick, OH job
OneGI is seeking a BC/ BE Gastroenterologist in Brunswick, Ohio. A terrific opportunity to join an outpatient practice that provides world-class care!
Highlights:
General GI Practice; 100% outpatient/ASC setting
APP support
Infusion, Pathology, Research, Anesthesia, Hem Banding available support services
1 ASC location with ownership potential
2-year practice partnership track
Benefits:
Competitive Base Salary with Competitive Production Earnings
Sign On Bonus and Moving Expenses
Medical, Dental, Vision, 401k Match
Malpractice Insurance
At One GI , we provide exceptional gastroenterology care that puts patients at the forefront. Since our inception in 2020, we have grown rapidly while remaining steadfast in our commitment to driving excellence and upholding the highest standards in gastroenterology practice. Our renowned physician leadership, collaborative team culture, state-of-the-art ancillary services, and robust network strength empower our physicians to deliver personalized, compassionate care tailored to each patient's unique needs.
One GI is more than just an organization; it's a community of over 1,300 dedicated individuals united by a shared purpose: creating a better healthcare experience for patients, colleagues, and communities. We are a diverse team of professionals who bring our unique perspectives and expertise to the table, fostering an environment of collaboration and continuous improvement. Each One GI practice is the leading provider of gastroenterology care in its respective community, retaining its regional name and unique reputation while leveraging the expansive resources and backing of our national organization.
Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status.
$164k-288k yearly est. 5d ago
Pharmacist - Relocation Assistance Available
Walgreens 4.4
Hamilton, OH job
Join Our Team at Walgreens as a Pharmacist! Why Walgreens - For You, For Your Family, For Your Future At Walgreens, pharmacists are medication experts and trusted healthcare providers reshaping the future of patient-focused care. With industry-leading resources, career advancement opportunities, and a strong commitment to work-life balance, we invest in you so you can invest in your patients.
For You - Competitive Pay & Flexible Scheduling
Competitive pay - Competitive wage offered based on geography and other business-related factors
Paid Time Off (PTO) - Available after three months of service (subject to state law) because work-life balance matters
Flexible scheduling - Flexible scheduling options to fit your lifestyle
For Your Family - Comprehensive Health & Wellness Benefits
Comprehensive benefits package including medical, prescription drug, dental, vision, disability and life insurance for qualifying team members. Plus free flu shots for all team members and other voluntary benefits
365 Get Healthy Here & Life365 Employee Assistance Program (EAP) - Mental health support and wellness programs
Family-forming support - Walgreens provides financial support for fertility treatments, including medical procedures and prescription medications. Eligible team members can also receive reimbursement for qualified adoption and surrogacy-related expenses
For Your Future - Growth, Education & Exclusive Perks
Opportunities for growth - Many pharmacists advance quickly into leadership roles in pharmacy operations, retail management, multi-site leadership, and corporate support functions
Walgreens University - Free training, certifications, and leadership development, plus tuition discounts at 30+ universities
Employee discounts - 25% off Walgreens brands and 15% off national brands, plus exclusive savings on electronics, travel, and more
401(k) with company match - Contribute to your retirement, and Walgreens provides matching contributions after one year and 1,000 hours of service. Additionally, Walgreens matches qualifying student loan payments as if they were 401(k) contributions
What You'll Do
Provide compassionate, expert-level pharmacy consulting services to patients
Educate and consult patients on medication usage, side effects, and cost-effective options
Deliver clinical healthcare services, including immunizations, diagnostic testing, and medication therapy management
Ensure medication safety through accurate compounding, dispensing, and regulatory compliance
Mentor and train pharmacy team members in a collaborative and supportive environment
Who You Are
Patient-focused & service-driven - You're committed to making healthcare personal
A collaborative team leader - You support, inspire, and uplift those around you
A lifelong learner - You stay ahead of industry advancements and professional growth
A problem-solver - You navigate challenges, from insurance claims to medication management, with ease
Apply Today & Build Your Future with Walgreens!
This is more than just a job-it's a career with purpose. See below for more details!
About Us
Founded in 1901, Walgreens (****************** proudly serves more than 9 million customers and patients each day across its approximately 8,000 stores throughout the U.S. and Puerto Rico. Walgreens has approximately 211,000 team members, including roughly 85,000 healthcare service providers, and is committed to being the first choice for pharmacy, retail and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities.
Basic Qualifications
BS in Pharmacy or Pharmacist Degree from an accredited educational institution.
Current pharmacist licensure in the states within the district.
Experience performing prescription dispensing activities that demonstrate a strong working knowledge of applicable state and federal controlled substance laws.
Certified Immunizer or willing to become an immunizer within 90 days of hire.
Preferred Qualifications
At least 1 year experience as a pharmacist in a retail setting including prescription filling and verification, records and legal compliance, pharmacy operations, pharmacy software and technology systems and insurance.
We will consider employment of qualified applicants with arrest and conviction records.
An Equal Opportunity Employer, including disability/veterans.
The Salary below is being provided to promote pay transparency and equal employment opportunities at Walgreens. The actual hourly salary within this range that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits. If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits
Salary Range: Pharmacist Hourly $64.60-$71.05
$29k-33k yearly est. 4d ago
Associate Actuary - Enterprise Growth Finance
Humana 4.8
Remote Humana job
Become a part of our caring community and help us put health first The Associate Actuary will be a key member of the Enterprise Growth Finance team. The Associate Actuary 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 trends to forecast the organization's short, medium and long-term financial position. The Associate Actuary's work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Associate Actuary will work as part of the Enterprise NPV team under Enterprise Growth Finance. The Associate Actuary ensures data integrity by developing and executing necessary processes and controls around the flow of data and associated modeling. Collaborates with stakeholders to understand business needs/issues, troubleshoots problems, conducts drilldown analysis, and develops resolutions for data anomalies. 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.
The Associate Actuary will focus primarily on:
LTV/NPV Modeling - Maintenance and enhancement of MA-IND NPV models, and creation of NPV modeling for CenterWell lines of business
Ad Hoc Analysis - Deep-dives into NPV modeling to provide new insights needed for utilization of the model in business situations
Use your skills to make an impact
Required Qualifications
Bachelor's Degree
Associate of Society of Actuaries (ASA) designation
MAAA
Strong communication skills, with experience in collaborative work across functions
Advanced Excel and SAS/SQL skillset
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
Prior Humana MA and/or CenterWell experience
Prior Experience with LTV/NPV modeling
Databricks and Power BI experience
Additional Information
This position can work from home from anywhere in the US.
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: 01-30-2026
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.
$106.9k-147k yearly Auto-Apply 19d ago
Sr. Program Delivery Professional IWHA-Interoperability
Humana 4.8
Remote Humana job
Become a part of our caring community and help us put health first The Senior Program Delivery Professional strategically identifies, develops, and implements programs that influence providers, members or market leadership towards value-based relationships and/or improved quality metrics. The Senior Program Delivery Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Program Delivery Professional - IHWA Interoperability plays a key role in driving seamless data integration and collaboration within the In-Home Health and Wellbeing Assessment (IHWA) team and across interoperability initiatives. Serving as a business subject matter expert (SME), this individual partners closely with internal and external stakeholders, as well as the Interoperability team, to advance program objectives.
Key responsibilities include collaborating with leaders on implementation planning, reviewing and communicating program results, and contributing to the ongoing improvement of processes and automation. The role also begins to influence departmental strategy and requires independent decision-making on moderately complex to complex technical matters related to project components. Work is performed without direct supervision, with considerable latitude in determining objectives and approaches to assignments.
The ideal candidate demonstrates a collaborative approach, a strong interest in technology solutions, and a commitment to continuous process improvement.
Use your skills to make an impact
Required Qualifications
Minimum three, (3) years of IT project management or business process automation, experience in technology solutions.
Excellent communication skills, both oral and written
Proven experience in interoperability or data integration within a healthcare or technology setting.
Strong problem-solving skills with demonstrated success in process improvement initiatives and process automation.
Familiarity with various technology solutions and interest in exploring new innovations.
Excellent collaboration, and stakeholder management abilities.
Experience with managing and monitoring successful and impactful projects.
Self-starter with the ability to work independently and as part of a team.
Futuristic and broad thinker with attention to detail and downstream impacts.
Preferred Qualifications
Bachelor's degree in Information Technology, Computer Science, Information Systems, or a related field.
Experience with EHR integration or usage.
Experience with AI integration.
Experience automating business processes.
PMP certification a plus
Knowledge and experience in health care environment/managed care
Strong analytical skills
Workstyle: Open for Hybrid or Remote Work at Home
Location: U.S.
Schedule: 8:00 AM - 5:00 PM Eastern Time Monday through Friday
Travel: occasional onsite as business needs require.
Work at Home Guidance 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. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
SSN Alert Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website.
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.
$86,300 - $118,700 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 01-08-2026
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
$86.3k-118.7k yearly Auto-Apply 10d ago
Pharmacy Operations Manager
Walgreens 4.4
Cleveland, OH job
Where state and federal laws/regulations allow, accountable for performing day-to-day non-clinical pharmacy operations, administrative activities; Ensures efficient pharmacy workflow and a positive patient experience. Serves as a full-time certified pharmacy technician.
Responsible for operating pharmacy systems to obtain patient and drug information and process prescriptions. Under the supervision of a pharmacist, supervising pharmacy technicians and pharmacy cashiers within the guidelines of authorized company policies, laws, regulations and business ethics.
Responsible for the selection, scheduling, and development of pharmacy technician personnel. Leads training, coaching, and performance management of pharmacy technicians. Makes decisions regarding performance management including discipline and termination.
Customer Experience
Engages customers and patients by greeting them and offering assistance with products and services. Resolves customer complaints, helps respond to customers' requests in a timely manner and answers non-clinical questions to ensure a positive customer experience. Models and shares customer service best practices.
Develops strong relationships with customers by anticipating customer needs and proactively offering services to provide the best experience possible when using the pharmacy. Enhances customer experience by increasing focus on healthcare services.
Operations
Responsible for assisting pharmacist in the delivery of patient care including patient registration, prescription data entry, preparation of medications for patients, counting, and verifying (where allowed by law). Completes patient and physician calls under the supervision of a pharmacist (where allowed by law). Under the supervision of a pharmacist assists with healthcare service offerings including administering vaccines, health screenings, and any health services allowed by law.
Within the guidelines of authorized company policies, state and federal laws/regulations, exercises independent judgment to delegate, direct, and assign non-clinical work in the pharmacy. Ensures tasks are completed on-time and holds others accountable for efficient workflow.
At the direction of the Pharmacy Manager or pharmacist, prepares, and files reports and records required by the company and various government agencies.
Manages core pharmacy workflow and drives excellence in pharmacy operations. Coordinates and organizes pharmacy daily schedule of activities. Recommends allocation of pharmacy hours. Assures the pharmacy is clean, neat, orderly, and stocked with adequate supplies.
Under the direction of the pharmacist, exercises independent judgment to ensure compliance and execution of all business administrative activities and pharmacy inventory management tasks that do not require pharmacist licensure. Manages annual inventory preparation.
Accountable for completion of non-clinical patient calls.
Drives new technology/ process roll out, champions change and engages team around action planning. Assures proper operation and maintenance of pharmacy department equipment. In collaboration with Pharmacy Manager, responsible for recordkeeping and ensuring security safeguards are in-place.
Under supervision of the pharmacist, strictly adheres to the Walgreen Co. policy regarding Good Faith Dispensing during all applicable prescription-dispensing activities and understands their role in ensuring that the elements of Good Faith Dispensing are met.
Maintains and applies knowledge of Company asset protection techniques. Supports Pharmacy Manager with diversion monitoring and reports any concerns that would compromise the security of the pharmacy to the Pharmacy Manager.
Communicates prescription errors to the accountable pharmacist, and adheres to Company policies and procedures in relation to pharmacy errors and the Continuous Quality Improvement Program.
Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment rejections. Follows-up with insurance companies as well as medical providers and conducts or participates in 3rd party audit.
Assists and supports Store Manager and Pharmacy Manager in analyzing and seeking to improve pharmacy financials, operational quality and customer service.
Manages Community Outreach Portal and coordinates and, at the direction of the Pharmacy Manager, assigns pharmacists to off-site immunization clinics and community events. Builds and sustains relationships with retail partnerships.
People & Performance Management
Leads performance management of technicians including making decisions and recommendations regarding discipline and termination. Follows constructive discipline policy to discipline, suspend, terminate or effectively recommend the same. Uses constructive discipline policy to ensure pharmacy technicians are compliant with state and federal laws. Holds technician accountable for attendance and timeliness. Maintains and improves performance of pharmacy through team member engagement and action planning.
Accountable for technician hiring, on-boarding, training, and scheduling. Monitors and holds pharmacy technicians accountable for timely training completion. Follows established policies and procedures set by the company for scheduling and training.
Accountable for identifying gaps in pharmacy operations knowledge among team members and supporting those team members in their training, either through hands-on training or assignment of learning modules.
Assists Pharmacy Manager in monitoring that all pharmacy and team member licensures, registrations and certifications are active and in good standing/ compliant with all regulatory and legal requirements. Leverages Walgreens resources such as Walgreens Online Verification System to assist in documenting licensure status.
Ensures proper procedures are followed for selection, recruitment, record retention, and training as required by Company policy and local, state and federal laws.
Training & Personal Development
Maintains PTCB certification through the designated PTCB training program and/or state required certification/registration.
Maintains and enhances current knowledge and skills related to pharmacy and healthcare.
Obtains necessary certifications, education credits and training such as LTMP e-modules as required by the Company. Follows performance improvement plans offered by Pharmacy Manager.
Seeks professional development by monitoring one's own performance, solicits for constructive feedback, and leverages Healthcare Supervisor as mentor and coach.
Communication
Communicates with pharmacy team, relaying messages from the support center or other key emails as required.
Participates in key store/pharmacy meetings, including 5-minute meetings and weekly check-ins with the Store Manager
Basic Qualifications
High School Diploma, GED, or equivalent.
PTCB or ExCPT certification (except in Puerto Rico).
Has one year of work experience as a pharmacy technician in a retail or hospital setting.
Must be fluent in reading, writing, and speaking English (except in Puerto Rico).
Requires willingness to work flexible schedule, including evening and weekend hours.
Willingness to obtain active immunization certification within 90 days of hire (except in Community Specialty Pharmacy and Health System Pharmacy locations)
Preferred Qualifications
Previous people management/ leadership experience.
Previous work experience with Walgreens with an Exceeding Expectation on last performance evaluation.
We will consider employment of qualified applicants with arrest and conviction records.
This information is being provided to promote pay transparency and equal employment opportunities at Walgreens. The current salary range for this position is $22.50 per hour - $31.00 per hour. The actual hourly salary within this range that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits. If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits
Salary Range: Hourly
$22.5-31 hourly 4d ago
Pharmacy Stars Improvement Lead
Humana 4.8
Remote Humana job
Become a part of our caring community and help us put health first
The Pharmacy Stars Improvement Lead will be a part of a collaborative Pharmacy Stars team which is accountable for Humana's Stars patient safety measure performance. The Pharmacy Stars Improvement Lead will autonomously develops, implements, and manages clinical program strategies to improve Medicare members' medication adherence and appropriate medication use with specific focus on telehealth and in-home methods of care delivery. The Pharmacy Stars Improvement Lead exercises independent judgment and decision making on complex issues regarding job duties and related tasks, works under minimal supervision, and analyzes variable factors to determine the best course of action.
Use your skills to make an impact
Required Qualifications
Bachelor's Degree in Business, Finance, Health Care or a related field
2 or more years of project leadership experience
Prior Medicare/Medicaid experience
Strategic thinking and planning capabilities; organized and detail-oriented
Excellent communication skills
Enthusiasm and motivation essential; a confident change-agent; strong presentation skills (oral and written)
Ability to operate under tight deadlines
Successful track record in facilitating and consulting across teams and managing projects
Ability to learn quickly, work under pressure and timeline, work with ambiguity, and make complex decisions as necessary to meet business need
Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data
Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
Preferred Qualifications
Master's Degree in Business Administration, Health Administration or a related field
Provider relations experience
Prior managed care experience
Understanding of metrics, trends and the ability to analyze and identify gaps in care
Proven organizational and prioritization skills and ability to collaborate with multiple departments a plus
Understanding of CMS Stars and performance measure knowledge and experience a plus
Background working in quality improvements
Additional Information:
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.
Work at home requirements:
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
SSN Alert:
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website.
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: 01-15-2026
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.
$104k-143k yearly Auto-Apply 4d ago
Bilingual Dispatch Coordinator
Humana 4.8
Humana job in Ohio
Become a part of our caring community and help us put health first The Dispatch Coordinator is an entry level position. Key tasks include managing and interpreting data from the Electronic Medical Records (EMR) system, which encompasses patient history, equipment needs, and insurance details. This role acts as an essential link between intake processing and fulfillment teams, ensuring accurate coding and understanding of equipment specifications prior to dispatch. A deep knowledge of the types of medical equipment and their setup requirements is crucial for effective order entry and route planning. This role requires a blend of technological proficiency and logistical planning to efficiently handle equipment delivery orders. Works within defined parameters under direction to identify work expectations and quality standards.
The Dispatch Coordinator handles high-volume medical orders ranging from urgent hospital discharges to routine equipment pickups. Primary responsibilities include analyzing work orders, understanding the specific requirements and urgency of each, and then prioritizing and organizing them into efficient geographical routes. Develop and manage daily routes per territory, considering factors such as order complexity, cycle times, and delivery setups. This role involves coordinating various types of deliveries, pickups, and exchanges in diverse settings, both in urban and rural locations. This role adheres to standard policies and practices but offers some room for interpretation, deviation, and independent discretion.
Use your skills to make an impact
Required Qualifications:
Bilingual (English and Spanish)
1-2 years of experience in medical equipment, DME, healthcare, or logistics/warehouse roles
Logistical aptitude with the ability to review maps, traffic patterns, and geography
Strong organizational skills, time management, and critical thinking abilities
Teamwork and collaboration skills
Effective communication skills with a focus on customer service
Preferred Qualifications:
Medical coding knowledge
Familiarity with medical equipment
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.
$39,000 - $49,400 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
About OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients' homes. OneHome's patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
$39k-49.4k yearly Auto-Apply 19d ago
Content Designer
Humana 4.8
Remote Humana job
Become a part of our caring community and help us put health first Humana is committed to innovative digital experiences that improve our members' quality of life and the interactions they have with us. We are looking for a content designer who is passionate about digital content and the critical role it plays in customer experience. As a member of Humana's Consumer Digital team, you will be responsible for defining and creating content that ensures people get the information they need to successfully choose and use their plans.
By partnering with leaders from business, research, design, technology, marketing and legal and compliance, you will ensure we get the right information, in the right ways, at the right times to audiences that include consumers, members, providers, employers and agents.
As the Content Designer, you will:
Create content strategies and direct information hierarchy, content types, voice and tone to ensure content is aligned to established audience and business objectives, research insights, brand standards, legal and compliance requirements, accessibility best practices and digital standards
Collaborate with other UX experts on content organization, navigation, site maps and information architecture
Seek simplicity, distilling complex concepts into clear, concise and contextual content and taxonomies
Create and manage copy for all steps of the digital experience, including headlines, product summaries and comparison, alt text, microcopy, buttons, navigation and error messaging
Develop tools such as content matrices and editorial calendars to track and manage content updates
Regularly audit and inventory online content to identify gaps in quality, compliance, standards and branding
Continuously improve digital content, including partnering to identify research needs, mining user data and insights and conducting competitive assessments
Maintain Humana digital content guidelines, standards, tools and processes
Use your skills to make an impact
Required Qualifications
Bachelor's Degree in English, Journalism or similar field
At least 3+ years of content strategy and UX writing experience
E-commerce experience
Experience writing and optimizing content for a variety of content types, digital channels and secure portals
Well-organized and detail-oriented, capable of handling multiple projects simultaneously, and able to move between strategic and tactical work
Familiar with working in a regulatory environment that requires legal and compliance oversight
Excellent verbal, written, and presentation skills
Experience with collaboration and agile technology, such as Jira
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.
$65,000 - $88,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 01-01-2026
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.
$65k-88.6k yearly Auto-Apply 17d ago
Category Management Advisor
Cigna Group 4.6
Remote or Bloomfield, CT job
The Category Management Advisor is a strategic sourcing professional responsible for end-to-end sourcing and contracting for technology solutions across Cigna, including software and software-as-a-service (SaaS). This role drives sourcing strategies globally, manages competitive processes, negotiates agreements, and recommends suppliers that best align with business objectives.
You will collaborate with internal stakeholders-including Business, IT, Legal, Information Protection, and Privacy-to negotiate complex technology agreements. The ideal candidate has experience managing multiple negotiations simultaneously, adapting to dynamic requirements tied to strategic business and IT objectives, and influencing stakeholders at various management levels.
Responsibilities:
Lead and manage the sourcing process from initiation to execution, ensuring stakeholder engagement and alignment.
Develop category strategies considering market trends, spend analysis, strategic importance, and geographic factors.
Drive sourcing initiatives across the organization, managing multiple stakeholders and competing priorities.
Create timelines and organize cross-functional teams to support negotiations and contracting.
Identify and execute sourcing opportunities that deliver cost savings, risk reduction, improved business outcomes, and enhanced service.
Draft, review, and revise contracts, SLAs, Statements of Work, and Change Orders to optimize benefits and minimize risk.
Mentor teams to understand enterprise-wide category needs and evaluate best-in-class suppliers.
Monitor market conditions and cost drivers to forecast trends and inform sourcing strategies.
Promote continuous improvement in sourcing and procurement processes.
Build and maintain strong relationships with suppliers, stakeholders, and internal business partners.
Act as a change agent and mentor, demonstrating adaptability and resilience.
Provide analysis and insights to support decision-making and category initiatives.
Drive total cost of ownership reductions and business improvements through supplier partnerships.
Establish yourself as a trusted advisor to business units.
Qualifications:
Bachelor's degree in Business, Supply Chain, or related field preferred.
5+ years of relevant experience in sourcing or procurement.
Proven experience negotiating software and SaaS contracts.
Strong project management skills with the ability to manage multiple priorities.
Excellent verbal and written communication skills.
Demonstrated leadership ability to influence and motivate cross-functional teams.
Highly organized with strong time management and attention to detail.
Skilled in structured problem-solving and fact-based negotiation tactics.
Strong analytical, interpersonal, and collaboration skills.
Knowledge of procurement and outsourcing principles, theories, and processes.
Ability to thrive in a dynamic, fast-paced environment with periods of ambiguity.
Experience drafting and reviewing complex contracts, including MSAs and SOWs.
Familiarity with eSourcing tools such as Ariba and Icertis.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
$50k-86k yearly est. Auto-Apply 18d ago
Fraud and Waste Investigator
Humana 4.8
Remote Humana job
Become a part of our caring community and help us put health first Humana is looking for an experienced Healthcare Investigator to join its industry leading Special Investigations Unit. Do you enjoy speaking with members, providers, and other industry colleagues? Do you thrive on solving problems and thinking outside the box? Are you self-driven and enjoy being proactive? But, most of all do you have a passion for combating Fraud, Waste, and Abuse in the Health Care Industry? If this resonates with you, then you should strongly consider this amazing opportunity to join Humana's SIU.
The Fraud and Waste Professional conducts investigations of allegations of fraudulent and abusive practices. The Fraud and Waste Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Fraud and Waste Investigator collaborates in investigations with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares investigative and audit reports. Begins to influence department's strategy. Makes decisions on issues regarding technical approach for project components. Exercises good judgment with considerable latitude in determining objectives and approaches to assignments.
In order to thrive in this role, the following attributes and experience would be helpful:
o Self-starter and organized
o Interview skills and able to conduct a thorough investigation to maintain compliance with Humana and governmental requirements
o Able to collaborate with internal and external partners (Law Enforcement, Legal, Compliance).
o Comfort with data analysis (Excel, Access, PowerBI), report writing, and creating/presenting via PPT or other platform
o Performing Investigative research and medical record reviews
o CPT code experience
o Experience with testifying in Court
This role will regularly engage with all of the following:
o Local, State and Federal Law Enforcement
o Humana Legal and Outside Counsel
o Internal Compliance
o Market Areas
o Clinical Teams
o Business areas for all product lines (Medicare, Medicaid, Commercial)
o Industry Trend areas
Use your skills to make an impact
WORK STYLE: Work at Home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
WORK HOURS: Typical work hours are Monday-Friday, 8 hours/day, 5 days/week. EST/CST time zones
Required Qualifications
• Bachelor's degree
• 2 years of healthcare fraud investigations and auditing experience
• Knowledge of healthcare payment methodologies, claims, submissions, and payments
• Strong organizational, interpersonal, and communication skills
• Inquisitive nature with ability to analyze data to metrics
• Proficiency with MS Word, Excel, Access
• Strong personal and professional ethics
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
• Graduate degree and/or certifications (MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI)
• Experience testifying in court
• Understanding of healthcare industry, claims processing, and investigative process development
• Experience in a corporate environment and understanding of business operations
Additional Information
Work at Home Requirements
• WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
• A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
• Satellite and Wireless Internet service is NOT allowed for this role.
• A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
How We Value You
• Benefits starting day 1 of employment
• Competitive 401k match
• Generous Paid Time Off accrual
• Tuition Reimbursement
• Parent Leave
• Go365 perks for well-being
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Modern Hire, 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 Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 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.
#ThriveTogether #WorkAtHome
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.
$65,000 - $88,600 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 01-15-2026
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.
$65k-88.6k yearly Auto-Apply 4d ago
Electro-Mechanical Controls Engineer (Automation Engineer Lead Analyst) - Express Scripts
Cigna Group 4.6
Remote or Newark, DE job
Help us automate and maintain our future. Get ready for a job that encourages you to think strategically yet stay connected with your teams. Do you have problem-solving or strategy experience? If so, prepare to innovate, create, and inspire. The Pharmacy Automation Engineer (Automation Engineering Lead Analyst) is primarily responsible for providing first-level electrical and process Controls support for a highly-automated pharmaceutical filling and packaging system. Perform emergency, corrective, and preventive maintenance activities to restore equipment. In addition, key responsibilities will involve implementing equipment and system upgrades, engineering change controls, and continuous improvements. The position will support equipment installations, upgrades, or equipment expansions. Automation engineer also trains, mentors, and supports the development of other team members
Responsibilities
Performs advanced level maintenance and service on automated equipment by using and understanding electrical, mechanical, and pneumatic drawings and schematics, and using special test equipment and tools.
Maintains reliability of the pharmacy automation equipment by executing preventive, corrective, and emergency work orders.
Troubleshoot, service, install and repair automated production equipment, to include equipment modifications, upgrades, and spare parts inventory
Utilizes knowledge and skill to monitor and improve the Mean Time Between Failures (MTBF) of the electro-mechanical equipment, and supporting application software systems.
Observe system for degraded performance using routine inspections, maintenance rounds, and diagnostic equipment.
Use a computerized maintenance management system (MAXIMO) to record labor hours, repair parts, and monitor pharmacy equipment performance.
Recommend alterations to developers and designers to improve the quality or performance of processes and/or machines.
Interpret the output of the reporting systems and take appropriate action that will result in the removal of the root cause problem from the system on a permanent basis.
Document all emergency, corrective, and preventive maintenance work via work orders associated with Computerized Maintenance Management System (CMMS - MAXIMO).
Operates on-site in an on-call capacity.
Qualifications
High School diploma; Associates degree preferred.
Associate's degree in Industrial Maintenance or related technical field or 2+ years of maintenance experience in an industrial setting preferred.
0+ years of relevant experience with a Bachelor's Degree and mechanical electrical experience related to automated, industrial equipment preferred.
Experience working in high volume production or pharmaceutical environment.
Experience in troubleshooting complex PLC/computer-operated electro-mechanical equipment; PLC's, I/O, and field devices; repairing, setting up, adjusting, and tuning mechanical systems and pneumatic systems.
Experience using of all tools and procedures needed to repair precision electro-mechanical machinery successfully the first time.
Experience using preventive and predictive maintenance techniques.
Experience using Maintenance Management Systems (CMMS) to report and follow-up on maintenance procedures and work orders.
Flexibility to occasionally work outside of normal shift hours, including occasional weekends, as needed to satisfy operational requirements in support of customer demand.
Minimal travel to other ESI facilities or vendor sites is possible.
Shift schedule: Sunday - Thursday (6am-2:30pm).
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About The Cigna Group
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
$98k-122k yearly est. Auto-Apply 60d+ ago
Senior Learning Designer - IT Associate Skilling
Humana 4.8
Humana job in Columbus, OH or remote
**Become a part of our caring community and help us put health first** The Senior Learning Design Professional partners with IT leaders and associates to identify and address performance and knowledge gaps through strategic learning solutions. This role designs, delivers, and scales impactful learning experiences that build skills across the IT organization's associates. Leveraging performance consulting, adult learning theory, and instructional design best practices, the Senior Learning Design Professional develops content collaborates with subject matter experts (SMEs) and stakeholders at all levels of the organization, through executives to drive continuous improvement and measurable outcomes. The Senior Learning Design Professional begins to influence departmental strategy, makes decisions on moderately complex to complex issues, and perform work without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
Designs and develops engaging, learner-centered experiences that drive performance and skill development. Collaborate with subject matter experts to analyze learning needs, write effective learning objectives, and create instructional materials including storyboards, scripts, performance support tools, mobile learning, and manuals. Applies a consulting mindset to build solution-focused partnerships with stakeholders and subject matter experts, designing and delivering targeted learning experiences that skills and/or upskills IT associates and advance their technical and professional capabilities. Writes effective learning objectives and coordinates performance assessments to measure training effectiveness. Ensure course materials are current and relevant to training needs. Tracks and analyzes the training programs' effectiveness by examining learner's satisfaction levels, proficiency testing, and job performance improvement. Provides instruction and guidance to Facilitators. Knows how to select and use appropriate learning technologies to support development and delivery (Articulate, Vyond, Cornerstone on Demand, etc.) and collaborative tools to facilitate learning. Plans, organizes, develops and delivers training curriculum, materials, job performance aids and programs to meet specific training needs. Uses consultative skills to commit projects and conduct needs analysis with clients to determine whether learning solutions are necessary or relevant. Begins to influence department's strategy. Make 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. Comfort with leveraging AI to drive work outcomes. Additionally, plays a key role in
delivering engaging, learner-centered experiences that support skill development, knowledge acquisition, and performance improvement. This role may involve facilitating live and virtual sessions.
Key Responsibilities Include:
+ Independently conducts all learning activities (Learning Needs Analysis to Design and Development and Delivery) to support associate skilling.
+ As needed, designs, plans, and delivers/facilitates training around topics including Cloud and other skills IT Associates needs to succeed.
+ Partners with Associate Director to develop, refine, and prioritize the skilling roadmap, aligning future skills training with IT needs.
+ Reports progress upwardly and to all non-Executive stakeholders.
+ Manages the Intake process to capture and report on all requests coming into the learning team (course development, LMS updates, etc.).
+ Provide LMS support as needed for the team and, as availability allows, the rest of IT.
+ Supports the Associate Director in all reporting (e.g., and type of learning requests).
+ Manages learning tool license administration to ensure prudent allocation of these learning licenses across IT.
+ Consulting - Partners with Associate Director to provide consulting on incoming learning requests for IT colleagues that want to build their own training.
+ Support IT Learning Week, as needed.
+ Answers email from team Mailbox.
**Use your skills to make an impact**
**Required Qualifications**
+ Bachelor's degree in Instructional Design, Education, Learning Technology, Adult Education, similar field, or comparable experience.
+ 5+ years of experience designing and delivering learning solutions, including e-learning modules and facilitated learning events that support upskilling for technical audiences.
+ 3+ years of facilitating engaging in-person and virtual learning experiences using diverse instructional techniques.
+ Proven ability to communicate learning approaches, outcomes, and insights clearly and persuasively to stakeholders at all levels, including senior leadership and executive audiences.
+ Demonstrated ability to plan, execute, and manage learning projects effectively, including timelines, stakeholder communication, and risk mitigation.
+ Track record of successful training design, development and implementation experience using various methods (e.g., paper-based, facilitated, webcasts, e-learning).
+ Proficient in creating and editing multimedia learning assets using industry-standard tools, including Adobe Creative Suite (After Effects, Animate, Audition, Captivate, Express, Illustrator, Photoshop) and eLearning development platforms such as Articulate 360 and Adobe Captivate.
+ Experience managing courses in Cornerstone OnDemand or a similar LMS.
+ Highly organized with demonstrated ability to manage multiple projects, prioritize tasks effectively, and meet deadlines in a dynamic environment.
+ Strong knowledge of eLearning standards and Adult Learning Theory.
+ Demonstrated experience with instructional design models (e.g., ADDIE, SAM) and performance improvement approaches.
+ Detail-oriented with strong analytical skills to ensure accuracy, consistency, and effectiveness of all activities.
**Preferred Qualifications**
+ Master's degree in Instructional Design, Education, Learning Technologies, Adult Education, similar field, or comparable experience.
+ Certification in instructional design tools or methodologies (e.g., ATD, CPTD, Kirkpatrick).
+ Experience in IT environments and/or supporting IT associates.
**Additional Information**
Travel may be required for events.
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.
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.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$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: 01-04-2026
**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 ***************************************************************************
As a Strategic Account Executive, you are the face of Cigna to the client. Your focus is on spending time with clients in person to cultivate the relationship, addressing client issues, selling annual renewal rate increases in addition to new products and services to expand the relationship. You will be the trusted advisor and go-to partner for your clients, helping them navigate their business challenges and opportunities by offering strategic insights and ensuring an exceptional client and customer experience.
Key Responsibilities:
Client Partnership: Act as a key influencer and trusted advisor, cultivating strong, personal relationships with decision-makers and other key stakeholders.
Industry Expertise: Deeply understand your clients' businesses, their industries, and their unique challenges. Continuously learn and adapt, offering tailored recommendations that address both their immediate needs and long-term goals.
Relationship Building: Engage at all levels with both decision-makers and those who influence the decision-making process, ensuring Cigna's voice is heard and valued.
Market Insights: Keep clients informed about the latest industry trends, helping them stay ahead of the curve and leveraging Cigna's solutions to meet their evolving needs.
Financial & Underwriting Expertise: Strengthen your understanding of financials and underwriting to guide clients in managing their costs. Demonstrate the value of Cigna's solutions, including specialty products, and offer creative, proactive solutions to meet their needs.
Portfolio Management: Drive growth, earnings and retention across your client portfolio, meeting targets for both new business and renewals. Work to expand Cigna's relationships through cross-selling additional products and services.
Collaboration: Work closely with underwriting teams to ensure alignment, build trust, and ensure clients receive tailored, strategic solutions.
Client Experience: Oversee client service requests, ensuring seamless execution and swift resolution by directing them to the right team for problem-solving.
Channel Management: Manage key partner relationships to ensure client budgets align with reality, holding internal partners accountable and leveraging resources as needed to maintain success.
What You Bring:
Strong relationship-building skills and a passion for developing deep client connections
Expertise in financials, underwriting, and providing strategic solutions
A collaborative mindset with the ability to work effectively across teams
Proactive, creative thinking to develop tailored solutions for each client
A desire to grow with a company that's committed to delivering innovative solutions in an ever-changing industry
At Cigna, we value people who bring both strategic insight and a hands-on approach to client management. If you're driven by client success and want to work for an organization that values both innovation and personal relationships, we want to hear from you!
Qualifications
Bachelor's degree or equivalent experience.
Experience: 3+ years of experience in health benefits or client management
Skills:
Strong communication, sales negotiation, and relationship-building skills.
Proven ability to manage and grow client relationships, particularly with clients
Experience in sales, marketing, underwriting, or operations is preferred.
Financial acumen with the ability to identify and drive growth opportunities within the book of business.
Additional: Demonstrated success in managing large, complex client accounts with a focus on relationship-building and revenue growth.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
About Cigna Healthcare
Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
$86k-116k yearly est. Auto-Apply 43d ago
Revenue Integrity Director- Remote
Tenet Healthcare Corporation 4.5
Remote or Frisco, TX job
The Director of Revenue Integrity serves in a senior leadership capacity and demonstrates client and unit-specific leadership to Revenue Integrity personnel by designing, directing, and executing key Conifer Revenue Integrity processes. This includes Charge Description Master ("CDM") and charge practice initiatives and processes; facilitating revenue management and revenue protection for large, national integrated health systems; regulatory review, reporting and implementation; and projects requiring expertise across multiple hospitals and business units. The Director provides clarity for short/long term objectives, initiative prioritization, and feedback to Managers for individual and professional development of Revenue Integrity resources. The Director leverages project management skills, analytical skills, and time management skills to ensure all requirements are accomplished within established timeframes. Interfaces with highest levels of Client Executive personnel.
* Direct Revenue Integrity personnel in evaluating, reviewing, planning, implementing, and reporting various revenue management strategies to ensure CDM integrity. Maintain subject-matter expertise and capability on all clinical and diagnostic service lines related to Conifer revenue cycle operations, claims generation and compliance.
* Influence client resources implementing CDM and/or charge practice corrective measures and monitoring tools to safeguard Conifer revenue cycle operations; provide oversight for Revenue Integrity personnel monitoring statistics/key performance indicators to achieve sustainability of changes and compliance with regulatory/non-regulatory directives.
* Assume lead role and/or provide direction/oversight for special projects and special studies as required for new client integration, system conversions, new facilities/acquisitions, new departments, new service lines, changes in regulations, legal reviews, hospital mergers, etc.
* Serve as primary advisor to and collaboratively with Client/Conifer Senior Executives to ensure requirements are met in the most efficient and cost-effective manner; provides direction to clients for implementation of multiple regulatory requirements.
* Serve as mentor and coach for Revenue Integrity personnel and as a resource for manager-level associates.
* Maintain a high-level understanding of accounting and general ledger practices as it relates to Revenue Cycle metrics; guide client personnel on establishing charges in appropriate revenue centers to positively affect revenue reporting
FINANCIAL RESPONSIBILITY (Specify Revenue/Budget/Expense): Adherence to established/approved annual budget
SUPERVISORY RESPONSIBILITIES
This position carries out supervisory responsibilities in accordance with guidelines, policies and procedures and applicable laws. Supervisory responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
Direct Reports (incl. titles) : Revenue Integrity Manager/Supervisor
Indirect Reports (incl. titles) : Charge Review Specialist I-II, Revenue Integrity Analyst I-III, Charge Audit Specialist
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.
* Ability to set direction for large analyst team consistent with Conifer senior leadership vision and approach for executing strategic revenue management solutions
* Demonstrated critical-thinking skills with proven ability to make sound decisions
* Strong interpersonal communication and presentation skills, effectively presenting information to executives, management, facility groups, and/or individuals
* Ability to present ideas effectively in formal and informal situations; conveys thoughts clearly and concisely
* Ability to manage multiple projects/initiatives simultaneously, including resourcing
* Ability to solve complex issues/inquiries from all levels of personnel independently and in a timely manner
* Ability to define problems, collect data, establish facts, draw valid conclusions, and make recommendations for improvement
* Advanced ability to work well with people of vastly differing levels, styles, and preferences, respectful of all positions and all levels
* Ability to effectively and professionally motivate team members and peers to meet goals
* Advanced knowledge of external and internal drivers affecting the entire revenue cycle
* Intermediate level skills in MS Office Applications (Excel, Word, Access, Power Point)
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience required to perform the job.
* Bachelor's degree or higher; seven (7) or more years of related experience may be considered in lieu of degree
* Minimum of five years healthcare-related experience required
* Extensive experience as Revenue Integrity manager
* Extensive knowledge of laws and regulations pertaining to healthcare industry required
* Prior healthcare financial experience or related field experience in a hospital/integrated healthcare delivery system required
* Consulting experience a plus CERTIFICATES, LICENSES, REGISTRATIONS
* Applicable clinical or professional certifications and licenses such as LVN, RN, RT, MT, RPH, CPC-H, CCS highly desirable
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* While performing the duties of this job, the employee is regularly required to sit for long periods of time; use hands and fingers; reaching with hands and arms; talk and hear.
* Must frequently lift and/or move up to 25 pounds
* Specific vision abilities required by this job include close vision
* Some travel required
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
* Normal corporate office environment
TRAVEL
* Approximately 10 - 25%
Compensation and Benefit Information
Compensation
Pay: $104,624- $156,957 annually. Compensation depends on location, qualifications, and experience.
* Position may be eligible for an Annual Incentive Plan bonus of 10%-25% depending on role level.
* Management level positions may be eligible for sign-on and relocation bonuses.
Benefits
Conifer offers the following benefits, subject to employment status:
* Medical, dental, vision, disability, life, and business travel insurance
* Management time off (vacation & sick leave) - min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked.
* 401k with up to 6% employer match
* 10 paid holidays per year
* Health savings accounts, healthcare & dependent flexible spending accounts
* Employee Assistance program, Employee discount program
* Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
* For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act.
Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet participates in the E-Verify program. Follow the link below for additional information.
E-Verify: *****************************
The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.
**********
$104.6k-157k yearly 44d ago
Pharmacist
Walgreens 4.4
Austintown, OH job
Join Our Team at Walgreens as a Pharmacist! Why Walgreens - For You, For Your Family, For Your Future At Walgreens, pharmacists are medication experts and trusted healthcare providers reshaping the future of patient-focused care. With industry-leading resources, career advancement opportunities, and a strong commitment to work-life balance, we invest in you so you can invest in your patients.
For You - Competitive Pay & Flexible Scheduling
Competitive pay - Competitive wage offered based on geography and other business-related factors
Paid Time Off (PTO) - Available after three months of service (subject to state law) because work-life balance matters
Flexible scheduling - Flexible scheduling options to fit your lifestyle
For Your Family - Comprehensive Health & Wellness Benefits
Comprehensive benefits package including medical, prescription drug, dental, vision, disability and life insurance for qualifying team members. Plus free flu shots for all team members and other voluntary benefits
365 Get Healthy Here & Life365 Employee Assistance Program (EAP) - Mental health support and wellness programs
Family-forming support - Walgreens provides financial support for fertility treatments, including medical procedures and prescription medications. Eligible team members can also receive reimbursement for qualified adoption and surrogacy-related expenses
For Your Future - Growth, Education & Exclusive Perks
Opportunities for growth - Many pharmacists advance quickly into leadership roles in pharmacy operations, retail management, multi-site leadership, and corporate support functions
Walgreens University - Free training, certifications, and leadership development, plus tuition discounts at 30+ universities
Employee discounts - 25% off Walgreens brands and 15% off national brands, plus exclusive savings on electronics, travel, and more
401(k) with company match - Contribute to your retirement, and Walgreens provides matching contributions after one year and 1,000 hours of service. Additionally, Walgreens matches qualifying student loan payments as if they were 401(k) contributions
What You'll Do
Provide compassionate, expert-level pharmacy consulting services to patients
Educate and consult patients on medication usage, side effects, and cost-effective options
Deliver clinical healthcare services, including immunizations, diagnostic testing, and medication therapy management
Ensure medication safety through accurate compounding, dispensing, and regulatory compliance
Mentor and train pharmacy team members in a collaborative and supportive environment
Who You Are
Patient-focused & service-driven - You're committed to making healthcare personal
A collaborative team leader - You support, inspire, and uplift those around you
A lifelong learner - You stay ahead of industry advancements and professional growth
A problem-solver - You navigate challenges, from insurance claims to medication management, with ease
Apply Today & Build Your Future with Walgreens!
This is more than just a job-it's a career with purpose. See below for more details!
About Us
Founded in 1901, Walgreens (****************** proudly serves more than 9 million customers and patients each day across its approximately 8,000 stores throughout the U.S. and Puerto Rico. Walgreens has approximately 211,000 team members, including roughly 85,000 healthcare service providers, and is committed to being the first choice for pharmacy, retail and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities.
Basic Qualifications
BS in Pharmacy or Pharmacist Degree from an accredited educational institution.
Current pharmacist licensure in the states within the district.
Experience performing prescription dispensing activities that demonstrate a strong working knowledge of applicable state and federal controlled substance laws.
Certified Immunizer or willing to become an immunizer within 90 days of hire.
Preferred Qualifications
At least 1 year experience as a pharmacist in a retail setting including prescription filling and verification, records and legal compliance, pharmacy operations, pharmacy software and technology systems and insurance.
We will consider employment of qualified applicants with arrest and conviction records.
An Equal Opportunity Employer, including disability/veterans.
The Salary below is being provided to promote pay transparency and equal employment opportunities at Walgreens. The actual hourly salary within this range that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits. If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits
Salary Range: Pharmacist Hourly $58.70-$64.60
$58.7-64.6 hourly 4d ago
Behavioral Health Advocate (Call Center) - Evernorth Behavioral Health - Remote
Cigna Group 4.6
Remote job
Do you have a bachelor's degree and are ready for a meaningful career where you can make an impact and improve lives? Join us as a Behavioral Health Customer Service Advocate- an inbound call center role focused on helping people access needed care. You'll support members and providers seeking services for mental health and/or substance use disorders. This position features a structured work schedule with a designated queue time.
Using empathy, active listening, multitasking, and problem-solving skills, you'll help ensure every caller's experience with Evernorth is both efficient and compassionate.
Key Responsibilities:
Take back-to-back phone calls from members and providers (calls last about 8-10 minutes).
Triage and conduct intake for risk of harm and substance use concerns
Communicate eligibility, assist with scheduling appointments and providing referrals, quote benefits, and advise on authorization requirements
Utilize resources and independent judgment to deliver accurate information, exceptional service, and resolution on the first call
Collaborate with matrix partners and coordinate seamless handoffs to clinical teams for timely support
Navigate multiple systems and applications across multiple screens while on calls (sometimes up to 9 programs at once)
Requirements:
Bachelor's degree in psychology, social work, or a related field, or bachelor's degree in another field plus 2+ years of behavioral health experience.
Customer service experience
Strong time management and multitasking abilities
Proficiency with typing and PC usage
Must remain at your workstation while handling calls from a phone queue
Training schedule: Monday-Friday, 8:30 AM-5:00 PM CST
Work schedule: a permanent 8-hour shift between the hours of 7am-7pm CST will be offered based on business need.
If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.For this position, we anticipate offering an hourly rate of 19 - 29 USD / hourly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email: ********************* for support. Do not email ********************* for an update on your application or to provide your resume as you will not receive a response.
The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Zippia gives an in-depth look into the details of Humana, including salaries, political affiliations, employee data, and more, in order to inform job seekers about Humana. The employee data is based on information from people who have self-reported their past or current employments at Humana. The data on this page is also based on data sources collected from public and open data sources on the Internet and other locations, as well as proprietary data we licensed from other companies. Sources of data may include, but are not limited to, the BLS, company filings, estimates based on those filings, H1B filings, and other public and private datasets. While we have made attempts to ensure that the information displayed are correct, Zippia is not responsible for any errors or omissions or for the results obtained from the use of this information. None of the information on this page has been provided or approved by Humana. The data presented on this page does not represent the view of Humana and its employees or that of Zippia.
Humana may also be known as or be related to Humana, Humana Inc, Humana Inc., Humana Insurance Co. (Invt Port) and Humana, Inc.