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  • Senior Counsel - Healthcare IT and AI Technology Contracts

    Akron Children's Hospital 4.8company rating

    North Canton, OH jobs

    Full-Time, 40 hours/week Monday - Friday 8 am - 5 pm Onsite The Senior Associate Counsel provides legal support for hospital information technology operations, including comprehensive legal and strategic guidance on the procurement, deployment, and governance of information technology systems (ISD) and artificial intelligence. This position reports to the Vice President, Senior Associate Counsel with a reporting matrix to the Chief Information Officer. Responsibilities: Advise hospital leadership and procurement teams on the legal implications of acquiring new technologies, such as electronic health records (EHR), telemedicine platforms, cybersecurity tools, and medical devices and the implementation of artificial intelligence tools. Draft, review, and negotiate a broad array of information technology contracts-such as software-as-a-service (SaaS) agreements, cloud hosting terms, data processing addenda, and business associate agreements. Identify and address legal risks in vendor offerings and technology solutions. Advise hospital leadership on legal considerations surrounding digital transformation initiatives, innovation adoption, and strategic partnerships with technology providers. Collaborate with hospital IT and security teams to develop policies and protocols for safeguarding patient data and critical systems. Advise on incident response plans, breach notification procedures, and risk mitigation strategies. Stay abreast of emerging threats and evolving best practices. Provide legal support for hospital-wide policies on technology use, social media, device management, remote work, mobile access to sensitive information, and enterprise risk for information technology. Ensure policies reflect current legal requirements and operational needs. Support the hospital in managing disputes or litigation related to technology vendors, data breaches, intellectual property claims, and other technology-related matters. Coordinate with litigation counsel as needed. Education and Training: Provide ongoing education to staff and leadership on legal implications of technology adoption, emerging regulatory requirements, and evolving risks in the health technology landscape. Identify and assess legal, operational, and compliance risks in IT contract. Other duties as assigned. Other information: Technical Expertise Openness to learning and keeping pace with rapid changes in both healthcare delivery and technological innovation. Aptitude for working effectively with clinicians, IT professionals, administrators, vendors, and regulators. Capacity to guide organizational leadership through complex legal and strategic decisions regarding technology investments. Resourcefulness and creativity in navigating novel legal challenges emerging from digital health transformation. Education and Experience Education: Juris Doctor (JD) degree from an accredited law school; Ohio bar admission or ability to obtain admission prior to start date. Experience: Minimum of 5 years of legal practice advising in healthcare Information technology contracts is required. Technical Knowledge: Familiarity with healthcare IT systems, data privacy and security laws, and emerging technologies (such as artificial intelligence, cloud computing, and IoT). Skills: Strong contract negotiation, drafting, and analytical skills. Excellent verbal and written communication abilities. Competency in risk assessment and strategic thinking. Demonstrated integrity, discretion, and ability to work collaboratively with multidisciplinary teams. Full Time FTE: 1.000000 Status: Onsite
    $97k-148k yearly est. 9d ago
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  • Lead - Medicaid and Group Medicare Project Management

    Humana Inc. 4.8company rating

    Washington, DC jobs

    Become a part of our caring community and help us put health first The Project Management Lead manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Project Management Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Project Management Lead designs, communicates, and implements an operational plan for completing the project; monitors progress and performance against the project plan; takes action to resolve operational problems and minimize delays. Identifies, develops, and gathers the resources to complete the project. Prepares designs and work specifications; develops project schedules, budgets and forecasts; and selecting materials, equipment, project staff, and external contractors. Communicates with other operational areas in the organization to secure specialized resources and contributions for the project. Conducts meetings and prepare reports to communicate the status of the project. Sets priorities, allocates tasks, and coordinates project staff to meet project targets and milestones. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action. Key Responsibilities Collaborate with market partners and HPS team members to prioritize project requests Develop project plans, timelines and update cadence for all projects Document and circulate project risks, and develop risk mitigation strategy Set clear expectations on project timelines, scope, etc. Identify and secure funding for all project expenses Manage project meetings, ensuring appropriate participation, adherence to agenda and a focus on outcomes Develop communication and escalation pathways Communicate project status and timelines at the executive level Collaborate with internal HPS partners to obtain details necessary for prioritization (e.g. member experience improvements, compliance impacts, client goals, etc.) Create project intake and prioritization process, develop policy and procedure document for these processes, and ensure team members adhere to these processes Act as a mediator between stakeholders and project team members Manage project scope, document scope changes and impacts to timeline Adhere to client / government established deadlines Navigate client and vendor layers to ensure that all stakeholders are actively working to the same project plan and timelines Concurrently manage multiple projects Use your skills to make an impact Required Qualifications a Bachelor's degree or equivalent experience 2 or more years of project leadership experience, Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications managing complex PBM projects 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. $115,200 - $158,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-22-2026 About us About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient's well-being. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of 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 full accessibility rights information and language options ************************************************************* #J-18808-Ljbffr
    $115.2k-158.4k yearly 4d ago
  • Risk Adjustment Risk Lead & Compliance Strategist

    Humana Inc. 4.8company rating

    Washington, DC jobs

    A national healthcare organization is seeking a Risk Management Lead to oversee risk adjustment operations and compliance. This role requires a minimum of three years of project leadership experience and expertise in audit and compliance. The ideal candidate will have strong relationship-building skills and the ability to manage multiple projects effectively. This remote position offers a salary range of $104,000 to $143,000 annually, along with competitive benefits including health insurance and a 401(k) plan. #J-18808-Ljbffr
    $104k-143k yearly 4d ago
  • Director, AI Strategy & Transformation - Remote

    Humana Inc. 4.8company rating

    Washington, DC jobs

    A healthcare organization is seeking a Director to lead AI strategy within its IT Strategy team. This role involves harmonizing AI initiatives with business goals, leading cross-functional teams, and leveraging technological opportunities to enhance healthcare delivery. Candidates should have significant experience in strategy, leadership, and AI/ML applications. This position may require travel to offices and is based in the DC Metro area, with a salary range of $184,800 - $254,100 per year. #J-18808-Ljbffr
    $184.8k-254.1k yearly 5d ago
  • Maternity Care Authorization Specialist (Hybrid Potential)

    Christian Healthcare Ministries 4.1company rating

    Barberton, OH jobs

    This role plays a key part in ensuring maternity care bills are processed accurately and members receive timely support during an important season of life. The specialist serves as a detail-oriented professional who upholds CHM's commitment to excellence, compassion, and integrity. WHAT WE OFFER Compensation based on experience. Faith and purpose-based career opportunity! Fully paid health benefits Retirement and Life Insurance 12 paid holidays PLUS birthday Lunch is provided DAILY. Professional Development Paid Training ESSENTIAL JOB FUNCTIONS Compile, verify, and organize information according to priorities to prepare data for entry Check for duplicate records before processing Accurately enter medical billing information into the company's software system Research and correct documents submitted with incomplete or inaccurate details Verify member information such as enrollment date, participation level, coverage status, and date of service before processing medical bills Review data for accuracy and completeness Uphold the values and culture of the organization Follow company policies, procedures, and guidelines Verify eligibility in accordance with established policies and definitions Identify and escalate concerns to leadership as appropriate Maintain daily productivity standards Demonstrate eagerness and initiative to learn and take on a variety of tasks Support the overall mission and culture of the organization Perform other duties as assigned by management SKILLS & COMPETENCIES Core strengths like problem-solving, attention to detail, adaptability, collaboration, and time management. Soft skills such as empathy (especially important in maternity care), professionalism, and being able to handle sensitive information with care. EXPERIENCE REQUIREMENTS Required: High school diploma or passage of a high school equivalency exam Medical background preferred but not required. Capacity to maintain confidentiality. Ability to recognize, research and maintain accuracy. Excellent communication skills both written and verbal. Able to operate a PC, including working with information systems/applications. Previous experience with Microsoft Office programs (I.e., Outlook, Word, Excel & Access) Experience operating routine office equipment (i.e., faxes, copy machines, printers, multi-line telephones, etc.) About Christian Healthcare Ministries Founded in 1981, Christian Healthcare Ministries (CHM) is a health care sharing ministry for Christians. CHM is a nonprofit, voluntary cost-sharing ministry through which participating Christians meet each other's medical bills. The mission of CHM is to glorify God, show Christian love, and experience God's presence as Christians share each other's medical bills.
    $31k-35k yearly est. 3d ago
  • Clinical Case Manager Behavioral Health - Spanish Speaking - Work at Home

    CVS Health 4.6company rating

    Frankfort, IN jobs

    At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. Telephonic clinical case management with Medicare population.Uses Motivational Interviewing and engagement interventions to optimize member participation in case management programs. Completes a Comprehensive Assessment and Plan of care.Will document in clinical systems to support legacy Aetna and Coventry membership.Provides BH consultation and collaboration with Aetna partners.Active participation in clinical treatment rounds.Active participation in team activities focused on program development. Innovative thinking expected.The majority of time is spent at a desk on telephonic member outreaches and computer documentation.Assist members with locating community based behavioral health resources.Required Qualifications3+ years of direct clinical practice experience An active and unrestricted clinical behavioral health license in state of residence is required (ex: LPC, LCSW, LMFT, LPCC, LISW, LSW) Required to use a residential broadband service with internet speeds of at least 25 mbps/3mbps in order to ensure sufficient speed to adequately perform work duties. Some candidates may be eligible for partial reimbursement of the cost of residential broadband service Bilingual Spanish and English Preferred QualificationsCrisis intervention skills preferred Managed care/utilization review experience preferred Case management and discharge planning experience preferred Discharge planning experience Utilization review, prior authorization, concurrent review, appeals experience CCM preferred DSNP experience a plus Knowledge of Substance Abuse DisordersEducationMasters Degree in Social Work or Counseling required Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$54,095.00 - $116,760.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.For more information, visit ***************************************** We anticipate the application window for this opening will close on: 01/30/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
    $39k-51k yearly est. 4d ago
  • Chief Information and Innovation Officer

    Hoosier Hills 3.7company rating

    Jasper, IN jobs

    Join Our Award-Winning Team as the Chief Intelligence and Innovation Officer at Hoosier Hills Credit Union! Forbes has recognized Hoosier Hills Credit Union as one of Indiana's Top Three Credit Unions again in 2025, for the third consecutive year! Are you ready to lead a once-in-a-generation transformation? Hoosier Hills Credit Union is on a bold journey to redefine what a modern, member-centric financial institution looks like-and we need a visionary to guide the way. What We Offer Competitive Salary: $178,514 - $247,936 per year, commensurate with experience. Comprehensive Benefits Package: Health insurance, retirement plans, paid time off, incentive plans and more. Impactful Work: Driving continuous improvement in digital tools and infrastructure to meet evolving member needs and support long-term organizational growth. Supportive Environment: Collaborate with a team that values your contributions and supports your professional growth. A Rewarding Career: Make a difference in the lives of members and the communities we serve. Work Environment: This position is based on-site in Bedford, Indiana. Following the completion of your initial onboarding, you will have the flexibility to work remotely 1 to 2 days per week as part of our hybrid work model. Opportunity Overview As our Chief Intelligence and Innovation Officer (CIIO), you'll be the architect and strategic influencer of progress, blending technology modernization, data intelligence, and human-centered design into a future-ready strategy. We're looking for a leader who inspires with a values-driven mindset-someone who champions integrity, inclusivity, and collaboration, ensuring that our culture remains the foundation for growth and transformation. This isn't just a job-it's an opportunity to lead with purpose and shape the digital heartbeat of our organization and deliver exceptional experiences for both our members and team members. What You'll Do Enterprise Strategy and Leadership Define and implement a comprehensive enterprise innovation and intelligence strategy that aligns with the credit union's mission, vision, and multi-year strategic plan. Serve as a senior advisor to executive leadership and the Board of Directors on emerging technologies, data-driven opportunities, and long-term system modernization priorities. Foster a culture of innovation, disciplined experimentation, and cross-functional collaboration to advance enterprise performance and member value. Drive measurable progress in organizational intelligence, operational efficiency, and digital fluency across all business lines. Data Intelligence, Analytics, and AI Enablement Architect and govern a modern enterprise data and analytics ecosystem, encompassing data platforms, governance models, and team structures that support scalable insight generation and AI adoption. Advance the organization's capability to use predictive analytics and artificial intelligence in member personalization, lending strategy, risk management, and fraud prevention. Establish enterprise-wide standards for data integrity, quality, privacy, and compliance in alignment with NCUA, FFIEC, and other regulatory frameworks. Build a federated data model that connects centralized analytics teams with departmental experts to accelerate adoption and alignment of data-driven decision-making. Technology and Application Ecosystem Modernization Own the credit union's application and systems architecture, ensuring a modern, interoperable, and scalable technology ecosystem. Evaluate, build consensus, select, implement, and optimize best-in-class applications (core systems, CRM, digital banking, loan origination, etc.) that improve user experience and drive operational performance. Lead proactive release management processes to ensure the timely, well-communicated, coordinated, and risk-aware deployment of updates, features, and system enhancements. Partner with business units and focus groups to identify and prioritize feature enhancements that align with member and team member needs. Implement an API-driven framework that supports automation, integration, and agility across the enterprise. Continuously evaluate and optimize application performance, vendor solutions, and integrations to ensure alignment with strategic and operational objectives. Member and Team Experience Optimization Championing a human-centered design philosophy in all technology and data initiatives, balancing automation, ease of use, and risk mitigation. Partner with business leaders to initiate and lead internal focus groups across departments for observational learning to identify and eliminate friction points within both member and team member journeys, enhancing usability and productivity. Ensure systems empower staff through intelligent workflows, simplified interfaces, and accessible data insights that support timely, informed action. Utilize technology as a strategic lever to elevate both service quality and employee engagement. Innovation Governance, Vendor, and Risk Management Establish clear governance structures for innovation, technology investment, and enterprise change management. Oversee vendor strategy, ensuring technology partners deliver measurable value, performance accountability, and alignment with organizational standards. Collaborate with the Chief Information Security Officer, Risk, and Compliance leaders to maintain a secure, compliant, and resilient technology environment. Introduce structured evaluation processes for emerging technologies and fintech partnerships that enhance efficiency, differentiation, or revenue potential. Leadership, Culture, and Organizational Development Build and mentor high-performing teams across innovation, analytics, and application management disciplines. Promote professional development, interdisciplinary collaboration, and succession readiness within the technology and data organization. Lead by example in cultivating transparency, operational excellence, and enterprise accountability. Collaborate with the CISO and Infrastructure teams to drive accountability for system reliability, security, and compliance in partnership with IT, Risk, and Compliance functions. What We're Looking For Education: A Bachelor's degree in Information Systems, Computer Science, Business Administration, or related field from an accredited school. A Master's is preferred. Experience: 10+ years of leadership experience in innovation, technology strategy, or digital transformation, ideally within financial services. Proven track record of leading enterprise-level data strategy, business intelligence, and application ecosystem development. Proficiency in modern cloud and data environments (e.g., Azure, AWS, Snowflake, Databricks) and analytics tools (e.g., Power BI, Tableau, dbt, SQL, Python/R). Experience in proactively managing system releases, upgrades, and enhancements across cross-functional environments. Experience integrating modern platforms (e.g., APIs, cloud-based systems, CRM, analytics) into legacy environments. Expertise: Strong understanding of credit union operations, financial technologies, and regulatory frameworks (NCUA, FFIEC, GLBA, CCPA) and compliance in data and technology operations. Familiarity with AI/ML deployment, automation technologies, and emerging fintech applications. Proven ability to collaborate effectively with senior leadership and the Board of Directors to align technology strategy with organizational goals. Skills: Demonstrated ability to lead strategic innovation initiatives by driving digital transformation, applying member-centric design thinking, leveraging data-driven insights, managing organizational change, fostering cross-functional collaboration, and ensuring compliance with regulatory and risk standards. Judgment & Problem‑Solving: The ability to analyze complex situations, apply sound principles, and develop effective solutions. Deep passion for using innovation to deliver value, convenience, and trust to both members and team members. Hoosier Hills Credit Union is an Equal Employment Opportunity Employer. If you are a driven leader ready to make a meaningful impact and contribute to our continued success and growth, we invite you to apply! #J-18808-Ljbffr
    $178.5k-247.9k yearly 5d ago
  • Remote IT Vendor Lead - Network & Call Center Platforms

    Humana Inc. 4.8company rating

    Washington, DC jobs

    A health-focused service company located in Washington D.C. is seeking an experienced IT Vendor Management Lead. This position is responsible for managing mission-critical telecom suppliers, ensuring performance stability, optimizing spending, and enhancing service delivery. The ideal candidate should have extensive knowledge in IT vendor management, strong negotiation skills, and experience in managing large supplier portfolios in telecommunications and call center platforms. Competitive salary and benefits are offered, alongside opportunities for career growth. #J-18808-Ljbffr
    $89k-111k yearly est. 3d ago
  • Remote Global Regulatory Lead - TA Liaisons

    Gilead Sciences, Inc. 4.5company rating

    Washington, DC jobs

    A leading biopharmaceutical company is seeking an Associate Director to serve as Regional Regulatory Lead, overseeing complex regulatory submissions and managing cross-functional teams. The ideal candidate should have significant regulatory experience, a strong track record in strategy development, and excellent negotiation skills. This role offers a chance to influence drug development processes in a dynamic environment. #J-18808-Ljbffr
    $136k-195k yearly est. 4d ago
  • Director of Home Health Authorizations, Eligibility & Payor Maintenance

    Humana Inc. 4.8company rating

    Washington, DC jobs

    Become a part of our caring community and help us put health first A Director of Authorizations & Eligibility is a senior revenue cycle leader responsible for the strategic oversight, operational execution, and continuous improvement of all authorization, insurance eligibility re-verification and payer maintenance for a large, complex Home Health organization operating on the Homecare Homebase (HCHB) platform. This role leads enterprise-wide authorization related operations supporting high-volume, multi-branch environments and ensures timely, compliant payer approvals to protect revenue integrity and patient access. The Director partners closely with clinical leadership, operations, finance, compliance, and IT, and manages both onshore and offshore teams. The role also leads transformational initiatives related to centralization, automation, scalability, and payer optimization. Key Responsibilities Strategic Leadership & Governance Develop and execute a comprehensive authorization, eligibility reverification and payor encounter maintenance strategy aligned with enterprise revenue cycle objectives. Serve as the organizational subject-matter expert on payer authorization rules, revalidation requirements, and medical necessity workflows. Lead large-scale transformation initiatives including centralization, workflow redesign, automation, and performance standardization. Establish governance, escalation paths, and performance accountability across a complex, multi-site organization. Operational Oversight Direct day-to-day authorization, eligibility reverification and payor encounter maintenance operations across all service lines and payers. Ensure timely and accurate submission, tracking, and renewal of authorizations in Homecare Homebase. Oversee management of payer portals, authorization queues, and work distribution. Ensure consistent execution across onshore and offshore teams. Coordinate closely with Intake, Clinical Operations, Scheduling, Billing, and Denials teams. Clinical & Operational Collaboration Partner with nursing leadership, therapy leadership, and clinical staff to ensure clinical documentation supports medical necessity. Support resolution of clinical questions related to authorization determinations. Collaborate with Quality, Compliance, and Audit teams to support medical reviews and audits. Translate payer requirements into operational workflows and staff education. Performance Management & Analytics Define, monitor, and report KPIs including authorization turnaround time, authorization success rate, denial rate, and authorization-related delays. Use data to identify trends, root causes, and improvement opportunities. Present performance insights to executive leadership. Drive continuous improvement using Lean, Six Sigma, or similar methodologies. Compliance & Risk Management Ensure compliance with Medicare, Medicaid, and commercial payer authorization and revalidation requirements. Maintain audit-ready documentation and processes. Support external audits (MAC, SMRC, RAC, UPIC) and payer reviews related to authorization. Partner with Compliance and Legal teams on corrective action plans. People Leadership Lead, coach, and develop managers, supervisors, and frontline authorization staff. Manage blended onshore/offshore workforce models. Establish clear roles, performance expectations, and career pathways. Promote accountability, engagement, and operational excellence. Key Interfaces Branch Operational Staff and Leaders Clinical Operations Leadership (Nursing, Therapy, QA) Intake and Scheduling Teams Revenue Cycle Leadership Billing, Denials, and Appeals Teams Compliance, Legal, and Audit IT / Applications (Homecare Homebase) External Payers and Vendor Partners Use your skills to make an impact Requirements Education Bachelor's degree in Healthcare Administration, Business, Nursing, or related field required. Master's degree (MHA, MBA, MSN, or similar) preferred. Experience 8 or more years of progressive experience in healthcare revenue cycle or access operations. Minimum of 5 years leading authorization or insurance verification functions. Experience in large, complex, multi-site healthcare organizations. Demonstrated experience leading centralized and distributed (onshore/offshore) teams. Direct experience working with Homecare Homebase strongly preferred. Experience supporting Medicare, Medicare Advantage, Medicaid, and commercial payers. Proven success leading transformational or enterprise-scale process improvement initiatives. Skills & Competencies Deep knowledge of home health authorization, eligibility, and payer rules. Strong understanding of clinical workflows and medical necessity. Advanced operational and analytical skills. Ability to manage complexity, ambiguity, and change. Executive-level communication and influence skills. Strong collaboration across clinical, operational, and financial teams. Expertise in KPI-driven performance management. Preferred Certifications Certified Healthcare Access Manager (CHAM) Certified Revenue Cycle Professional (CRCP) Lean Six Sigma (Green Belt or higher) Project Management Professional (PMP) Nursing license (RN or LPN/LVN) preferred but not required Additional Information 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. Home or Hybrid Home/Office employees will be provided 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. $115,200 - $158,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-16-2026 About us About CenterWell Home Health: CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers - all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives. About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Centerwell, a wholly owned subsidiary of 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 full accessibility rights information and language options ************************************************************* #J-18808-Ljbffr
    $115.2k-158.4k yearly 3d ago
  • Senior Counsel - Healthcare IT and AI Technology Contracts

    Akron Children's Hospital 4.8company rating

    Akron, OH jobs

    Full-Time, 40 hours/week Monday - Friday 8 am - 5 pm Onsite The Senior Associate Counsel provides legal support for hospital information technology operations, including comprehensive legal and strategic guidance on the procurement, deployment, and governance of information technology systems (ISD) and artificial intelligence. This position reports to the Vice President, Senior Associate Counsel with a reporting matrix to the Chief Information Officer. Responsibilities: Advise hospital leadership and procurement teams on the legal implications of acquiring new technologies, such as electronic health records (EHR), telemedicine platforms, cybersecurity tools, and medical devices and the implementation of artificial intelligence tools. Draft, review, and negotiate a broad array of information technology contracts-such as software-as-a-service (SaaS) agreements, cloud hosting terms, data processing addenda, and business associate agreements. Identify and address legal risks in vendor offerings and technology solutions. Advise hospital leadership on legal considerations surrounding digital transformation initiatives, innovation adoption, and strategic partnerships with technology providers. Collaborate with hospital IT and security teams to develop policies and protocols for safeguarding patient data and critical systems. Advise on incident response plans, breach notification procedures, and risk mitigation strategies. Stay abreast of emerging threats and evolving best practices. Provide legal support for hospital-wide policies on technology use, social media, device management, remote work, mobile access to sensitive information, and enterprise risk for information technology. Ensure policies reflect current legal requirements and operational needs. Support the hospital in managing disputes or litigation related to technology vendors, data breaches, intellectual property claims, and other technology-related matters. Coordinate with litigation counsel as needed. Education and Training: Provide ongoing education to staff and leadership on legal implications of technology adoption, emerging regulatory requirements, and evolving risks in the health technology landscape. Identify and assess legal, operational, and compliance risks in IT contract. Other duties as assigned. Other information: Technical Expertise Openness to learning and keeping pace with rapid changes in both healthcare delivery and technological innovation. Aptitude for working effectively with clinicians, IT professionals, administrators, vendors, and regulators. Capacity to guide organizational leadership through complex legal and strategic decisions regarding technology investments. Resourcefulness and creativity in navigating novel legal challenges emerging from digital health transformation. Education and Experience Education: Juris Doctor (JD) degree from an accredited law school; Ohio bar admission or ability to obtain admission prior to start date. Experience: Minimum of 5 years of legal practice advising in healthcare Information technology contracts is required. Technical Knowledge: Familiarity with healthcare IT systems, data privacy and security laws, and emerging technologies (such as artificial intelligence, cloud computing, and IoT). Skills: Strong contract negotiation, drafting, and analytical skills. Excellent verbal and written communication abilities. Competency in risk assessment and strategic thinking. Demonstrated integrity, discretion, and ability to work collaboratively with multidisciplinary teams. Full Time FTE: 1.000000 Status: Onsite
    $97k-148k yearly est. 9d ago
  • Lead Software Engineer- IVR & Omnichannel APIs

    Humana Inc. 4.8company rating

    Washington, DC jobs

    Become a part of our caring community and help us put health first Humana is seeking a self-driven and collaborative Lead Software Engineer to join our Interactive Voice Response (IVR) team. In this role, you will deliver innovative IVR solutions and develop robust omnichannel APIs for our enterprise platforms. You will have the to drive the success of a high-impact, customer-facing application within a Fortune 50 company, working closely with multiple teams throughout the software development lifecycle (SDLC). Lead Software Engineer - IVR & Omnichannel APIs Humana is seeking a self-driven and collaborative Lead Software Engineer to join our Interactive Voice Response (IVR) team. In this role, you will deliver innovative IVR solutions and develop robust omnichannel APIs for our enterprise platforms. You will have the opportunity to drive the success of a high-impact, customer-facing application within a Fortune 50 company, working closely with multiple teams throughout the software development lifecycle (SDLC). Key Responsibilities Collaborate with team members to track and plan agile work supporting core cloud infrastructure. Partner with internal architecture and other enterprise teams to ensure a resilient, state-of-the-art cloud environment for a high-profile enterprise application. Develop and deliver proofs-of-concept (POCs) and sample implementations for widespread adoption within agile teams. Work with senior leadership to influence project timelines, deliverables, and strategic direction. Provide Tier 3 support during critical, high-impact incidents to ensure rapid resolution and minimal disruption. Humana is committed to fostering a collaborative and innovative work environment that supports personal and professional growth. Join us to help build solutions that directly impact millions of customers. Use your skills to make an impact Required Qualifications At least 8 years of experience in coding and development on cloud-based platforms Demonstrated experience with IVR systems or similar contact center technologies. Proven hands-on development expertise with large-scale cloud solutions. Strong background in designing and implementing API/Web Services. Excellent analytical, communication, organizational, and problem-solving abilities. In-depth knowledge of artificial intelligence (AI) implementation, testing, and monitoring processes. Preferred Qualifications Bachelor's degree or higher in computer science or a related field. Google Cloud (GCP) Contact Center. Experience with SQL and MongoDB databases. Previous experience supporting applications at a Fortune 100 company. Experience in creating MCP Servers Additional Information 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 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 #LI-Remote Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $129,300 - $177,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-29-2026 About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our accessibility resources. #J-18808-Ljbffr
    $129.3k-177.8k yearly 2d ago
  • Nutritionist - HYBRID

    Unity Health Care 4.5company rating

    Washington, DC jobs

    INTRODUCTION Unity Health Care has launched a Food Pharmacy Program, a collaborative effort with Capitol Area Food Bank, to combat food insecurity for senior patients aged 65 years of age and older. The Food Pharmacy will target seniors who have hypertension, diabetes and/or obesity at Unity's East of the River health center site. Under the supervision of the Medical Director, the Nutritionist will provide patient nutrition education and consultation. Also, the nutritionist will determine and prioritize the nutritional risks of clients based on established priority factors. MAJOR DUTIES Provides nutritional instructions to patients 65+ living with hypertension, diabetes and/or obesity. Disseminates Unity-CAFB designed toolkit that promotes health education around healthy foods etc., Provides nutrition-based patient health education on tailored food prescription to address the patient's medical and nutritional needs, taking into consideration food preferences and cultural background. Develops nutritional care plans for designated high-risk individuals and provides follow-up instructions, as required, to assure that the health and nutritional needs of the clients are adequately addressed. Coordinates nutritional care with other health care members in order to ensure comprehensive medical and social services for clients, including referrals for related services, such as Food Stamps, Medicaid benefits, as required. Keeps abreast of current research findings in nutrition health education and related nutritional needs to assure that appropriate and up to date intervention strategies are provided to participants. Reviews patient's medical records for medical history, laboratory results in order to provide nutritional instructions and develop an appropriate and feasible meal plan. Participates in Food Pharmacy related meetings to provide ongoing patient progress/overall updates. Assures that nutrition education, patient engagement and counseling services are documented, as appropriate in the medical record. Performs other duties as assigned. QUALIFICATIONS Bachelor's of Science degree in Food and Nutrition . Master's of Science in Food and Nutrition or related area preferred. Current Registered Dietitian DC License. Current Registered Dietician License preferred. Registered Dietitian with the American Dietetic Association. KNOWLEDGE & EXPERIENCE REQUIRED BY THE POSITION Bachelor's-level candidate must have minimum of two years of clinical experience. Master's candidate must have a minimum of one year of clinical experience, preferably in the area of infectious diseases. SUPERVISORY CONTROLS This position reports directly to the Medical Director, East of the River GUIDELINES This position abides by all rules and regulations set forth by applicable licensing and regulatory bodies, as well as UHC policies and Procedures. PERSONAL CONTACTS: This position has primary contact with the clients and employees of Unity Health Care. PHYSICAL DEMANDS Refer to attached ADA requirements. WORK ENVIRONMENT Refer to attached ADA requirements. OTHER SIGNIFICANT FACTS The incumbent must be able to balance the needs of diverse constituencies on a daily basis. RISKS The position involves everyday risk and discomfort, which require normal safety precautions typical of such places as offices, meetings, training rooms, and other UHC health Care Sites. The work area is adequately lit, heated, and ventilated. The position requires contact with staff at all levels throughout the organization. There are also external organizational relationships that may be a part of the work of this individual. All medical services shall be provided according to medically accepted community standards of care. The employee shall provide evidence of a recent (within the past twelve (12) months) health assessment that includes a PPD and/or chest x-ray results. The statements contained herein describe the scope of the responsibility and essential functions of this position but should not be considered to be an all-inclusive listing of work requirements. Individuals may perform other duties as assigned including work in other areas to cover absences or relief to equalize peak work periods or otherwise balance the workload.
    $50k-65k yearly est. Auto-Apply 60d+ ago
  • Integration Project Manager II - M&A/Managed Care experience

    Caresource 4.9company rating

    Dayton, OH jobs

    The Integration Project Manager II is responsible for managing medium to high complexity projects within programs and medium complexity standalone projects. Essential Functions: Responsible for successful delivery of integration projects at the workstream level Schedule and facilitate project meetings including weekly status meetings and stakeholder meetings Lead stakeholders in the refinement of the project charter Collaborate with business owners on the identification and assignment of business resources Capture and report on meeting notes, decisions, and action items Maintain workstream SharePoint site and project document repository Lead stakeholders in the current state documentation process Lead stakeholders in the future state recommendation process Develop and maintain project schedule Capture and consolidate IT and business estimates for project Accurately track and report project status against plan to stakeholders at all levels Escalate issues to Business Owner, Program Manager, and IMO Leadership as applicable Drive cross-functional communication between impacted business and IT areas Assess, manage, and control project scope, schedule, and budget change impacts Ensure project milestone deliverables are completed and approved at every stage of the project lifecycle Maintain project stakeholder matrix Assist with the continuous improvement of project management best practices, processes, and tools Collaborate with IT point of contact on the identification and assignment of IT resources Represent project in program meetings or in Portfolio Governance meetings Work with Talent Development and Communications to develop project communication and training plans Track, compile and report project metrics and budget Advocate for and adhere to IMO standards, tools and processes Implement mitigation strategies, contingency plans, and communicate/escalate to stakeholders Maintain RAID for project items Develop project operations and support plan Perform any other job duties as requested Education and Experience: Bachelor's Degree in Project Management, Business, Computer Science or related field or equivalent years of relevant work experience is required Minimum of two (2) years of healthcare insurance experience is required Minimum of one (1) years of project management experience is required Minimum of one (1) years of integration management experience is highly preferred Competencies, Knowledge and Skills: Must be comfortable leading workstream teams of subject matter excerpts through business requirements discovery phases. Experience with Microsoft Office tools, including Project, Word, PowerPoint, Excel, Visio, Teams, Outlook, etc. Experience working in project management software is preferred Demonstrates analysis and reporting skills Excellent decision making/problem solving skills Demonstrates interpersonal and relationship building skills Demonstrates critical listening and thinking skills Ability to effectively interact with all levels of the organization Excellent written and verbal communication skills Customer service oriented Ability to proactively, effectively and efficiently lead a project team of up to 15 core members and multiple external vendors Ability to prioritize work and team assignments to deliver projects on time, on budget, and meeting stakeholders expectations Demonstrates a sense of urgency Understanding of project management processes, techniques and tools, and development lifecycle (ideally Agile) Familiarity of and knowledge of Medicaid and Medicare a plus Licensure and Certification: Project Management Professional (PMP) certification is preferred Working Conditions: General office environment; may be required to sit or stand for extended periods of time High potential for remote work Compensation Range: $72,200.00 - $115,500.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type: Salary Competencies: - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-GB1
    $72.2k-115.5k yearly 4d ago
  • Hybrid CIIO: Chief Intelligence & Innovation Leader

    Hoosier Hills 3.7company rating

    Jasper, IN jobs

    A leading financial institution in Indiana is seeking a Chief Intelligence and Innovation Officer to spearhead technology modernization and data strategy. This role demands over a decade of experience in innovation or digital transformation, ideally in financial services. Responsibilities include defining innovation strategies and advising executive leadership. The position offers a competitive salary, comprehensive benefits, and a hybrid work model post-onboarding. #J-18808-Ljbffr
    $82k-106k yearly est. 5d ago
  • Director, Product Management - CenterWell Pharmacy Digital

    Humana Inc. 4.8company rating

    Washington, DC jobs

    Become a part of our caring community and help us put health first The Director, Product Management for CenterWell Pharmacy Digital leads the strategic vision, development, and delivery of CenterWell Pharmacy's website and mobile app experiences. This role is responsible for defining product strategy, driving innovation, and ensuring seamless, user‑centric digital solutions that support our patients' pharmacy needs and drive business objectives, including accelerating growth in payor agnostic markets. Additionally, the Director will lead a team of Product Owners (POs) and Product Managers (PMs), support their professional growth and development, and actively assist them in identifying and resolving risks and blockers that may impact product delivery and team performance. This role reports to the AVP of CenterWell Digital and collaborates closely with supporting CenterWell Pharmacy product teams, operational and service teams, and the executive leadership team. The Director is expected to be a strategic leader and a hands‑on problem solver, driving member engagement, satisfaction, and payor agnostic digital growth through innovation and alignment with enterprise business strategies. Key Responsibilities: Develop and articulate a clear product vision and strategy for CenterWell Pharmacy's digital channels, aligning with organizational goals, patient needs, and business growth priorities. Ensure product development efforts are tightly aligned with business growth strategy and key outcomes, supporting both membership growth and expansion in payor agnostic opportunities. Drive digital growth in payor agnostic areas by identifying, prioritizing, and executing capabilities that expand CenterWell Pharmacy's reach beyond Humana membership. Lead cross‑functional working partnership-including engineering, UX/UI, marketing, and operations-to deliver high‑quality digital products on time and within budget. Lead and mentor a team of Product Owners and Product Managers, supporting their ongoing growth, skill development, and career progression. Work closely with team members to proactively address risks, remove blockers, and foster a collaborative environment focused on delivering key business outcomes. Own the digital product roadmap; prioritize initiatives using data‑driven insights, customer feedback, market trends, and strategic business outcomes. Establish and monitor key performance indicators (KPIs) to measure product effectiveness, member satisfaction, script growth, and overall business impact. Partner with stakeholders across Pharmacy Operations, Engineering, Compliance, and Customer Service to ensure solutions meet regulatory standards and operational requirements. Oversee the product lifecycle: ideation, discovery, refinement, development, launch, and optimization. Champion a culture of continuous improvement, leveraging agile methodologies and best practices in product management. Represent CenterWell Pharmacy's digital product vision with senior leadership and external partners. Stay informed on the latest in healthcare, pharmacy, and digital trends to inform product strategy and vision. Use your skills to make an impact Qualifications: Bachelor's degree in Communication, Business, Pharmacy, or related field. A minimum of eight years of experience in product management, with at least 3 years leading digital products in healthcare, pharmacy, or a related field. Proven experience managing web and mobile product portfolios, ideally in a regulated environment. Demonstrated ability to lead and develop high‑performing teams. Strong analytical, strategic thinking, and communication skills. Familiarity with regulatory requirements for pharmacy and healthcare digital platforms. Experience working with agile development teams and tools. Preferred: Experience leading digital products in Centerwell pharmacy Additional Information Remote role 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 recommended; 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. $168,000 - $231,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole‑person well‑being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short‑term and long‑term disability, life insurance and many other opportunities. Application Deadline: 01-23-2026 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 *************************************************************************** #J-18808-Ljbffr
    $45k-61k yearly est. 3d ago
  • Infrastructure Operations Lead - Cloud and AI/GenAI Enablement

    Humana Inc. 4.8company rating

    Washington, DC jobs

    Become a part of our caring community and help us put health first The ideal candidate brings a passion for emerging technologies, a strong foundation in Infrastructure Operations and the curiosity and rigor to build next‑generation capabilities that improve healthcare delivery, reduce risk and optimize operational performance. If you're passionate about innovation and love working in an environment where you can constantly improve and adopt new technologies to drive business results, then Humana's Infrastructure Operations team could be the place for you! Use your skills to make an impact Key Responsibilities Lead and provide direction for our Managed Service Provider (MSP) Lead Managed Service Provider in Operations for Azure, GCP and AWS Cloud environment Drives moderate to complex processing improvements through optimization, enhancements and implementation of new operational features and functions around Cloud compliance, metrics/reporting and cost optimization Provide senior level expertise on decisions and priorities regarding the enterprise's overall Cloud Operations strategy, consumption, and optimization opportunities - understand Cost controls and the various cost optimization techniques Identifies, drives and assists in the implementation of opportunities to standardize Cloud environments Provides Cloud governance, processes and technical advisory support to business units and projects by working cross‑functionally and provides recommendations that support the business needs Participant as required (Level 2/3 escalation point) for Incident Management Participate and develop client relationships within Operations, Business partners, Managed Service Providers and Cloud Providers Work with cross-functional teams to support the engineering and implementation of new Cloud applications or solutions and define the related risks and onboard new capabilities Ability to communicate at all levels within an organization and influence strategic direction Ability to work with minimal supervision, making decisions based upon priorities, schedules and understanding business initiatives This leader will explore and prototype AI‑driven solutions to automate incident response, predict system failures, summarize complex telemetry data, and develop intelligent copilots to support Operations teams Lead research and evaluation of cutting‑edge AI and GenAI tools applicable to Infrastructure Operations (e.g., LLMs, vector databases, predictive analytics) Design and prototype AI‑driven systems for automated incident detection, anomaly classification, infrastructure forecasting/resiliency - leading to lower MttR and manual overhead in mission‑critical environments Develop and lead the strategic roadmap for AI adoption in Infrastructure Operations Collaborate with Infrastructure and Cloud Operations teams to pilot and integrate AI/GenAI features into critical workflows Modernize observability and alerting using AI/ML models for proactive monitoring and self‑healing actions Lead R&D of GenAI solutions for predictive alerting, incident triage and infrastructure automation Build AI copilots and natural language tools for infrastructure operations teams Integrate LLMs into observability platforms for real‑time RCA and log summarization Pilot and productionize GenAI‑based assistants, bots, and copilots to support ticket triage, knowledge management and resolution workflows Identify automation opportunities and implement AI‑enhanced runbooks, workflows and self‑healing mechanisms Contribute to a strategic roadmap for GenAI maturity within Infrastructure & Operations, including tools, governance and organizational readiness Partner with internal data science and clinical innovation teams to create proofs of concept, build ML/GenAI pipelines, and integrate with existing toolchains (e.g., ServiceNow, Splunk, Terraform) Autonomous log summarization, RCA generation and playbook suggestions Natural language interfaces for querying system health or telemetry Act as a GenAI ambassador, helping Infrastructure Operations teams upskill in AI‑augmented technologies and use cases Qualifications Bachelor's in Computer Science, Artificial Intelligence, Healthcare Informatics, or a related field 10+ years in infrastructure operations or engineering, with at least 3+ years of hands‑on involvement in AI/ML or GenAI R&D Deep understanding of large language models (LLMs), vector databases, retrieval‑augmented generation (RAG), and model orchestration (e.g., LangChain, Haystack). Experience integrating AI/GenAI capabilities with infrastructure automation tools (Terraform, Ansible, Python, Bash) Familiarity with healthcare systems and compliance frameworks (HIPAA, HITRUST) Proficiency with observability and telemetry platforms (e.g., Splunk, DynaTrace, SolarWinds) and AI‑driven monitoring Strong problem‑solving and experimentation mindset, with the ability to move from concept to pilot rapidly Experience with Continuous Integration and Deployment Pipelines, i.e. Azure DevOps, Jenkins, Git, Git Hub Has hands‑on scripting experience using one of the following: Terraform, Cloud Formation, PowerShell, Azure CLI, Python, JSON, Perl or Bash Preferred Master's degree Azure, AWS, GCP, ITIL and/or SRE certifications Experience with GenAI platforms (e.g., Azure OpenAI, Google Vertex AI) Experience deploying or evaluating open‑source LLMs or fine‑tuning models for infrastructure use cases Additional Information Work‑At‑Home Requirements WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. Satellite and Wireless Internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information#LI-Remote Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $142,300 - $195,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole‑person well‑being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short‑term and long‑term disability, life insurance and many other opportunities. Application Deadline: 01-14-2026 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 *************************************************************************** #J-18808-Ljbffr
    $142.3k-195.7k yearly 5d ago
  • Associate Director, Data Governance - Hybrid Leader

    Planned Parenthood Federation of America Inc. 4.4company rating

    Washington, DC jobs

    A leading healthcare organization seeks an Associate Director, Data Governance to develop and support the organization's data governance initiatives. This role requires at least 6 years in healthcare analysis or data governance, alongside a Bachelor's degree in a related field. The Associate Director will collaborate with various stakeholders to drive data quality and governance processes. The position offers a competitive salary range of $110,000 to $120,000 annually and follows a hybrid work model based in Washington, D.C. #J-18808-Ljbffr
    $110k-120k yearly 6d ago
  • Solutions Architect - K8s - AI Infrastructure Orchestration - REMOTE

    Living Talent 4.1company rating

    Denver, CO jobs

    Optimize Stateful Kubernetes & HPC works loads - including AI and GPUs Remote 1st Culture (US or Canada only) Series A Startup Base Salary $175k - $200K (depending on experience) + Equity Subject Matter Knowledge & Experience: External Client Interaction (Solutions Architecture - Pre Sales - Support) Containerization, Orchestration Kubernetes (Ops & integrating into Kubernetes) CLI expertise (Bash, Shell, Python, Go) Key Responsibilities Support, Guide, Design, and Integrate Solutions: Lead portions of external customer engagements ensuring seamless product implementation. Drive Platform Adoption and Client Success: Collaborate with internal teams (product, engineering, customer success) to promote platform adoption and ensure client satisfaction. Bridge gaps between teams to align strategies and deliver cohesive solutions that meet client needs. Master Cloud-Native Technologies and Services: Build deep expertise in cloud-native applications, microservices, and modern DevOps practices. Stay current with industry trends and leverage this to provide innovative, informed guidance and solutions to clients. Strategic Advice - Maximize Value - Advocacy creation Engage Clients - Technical Leaders including CloudOps, Systems, and similar. Build and nurture relationships with technical stakeholders. Offer strategic guidance to help clients fully leverage solutions, driving measurable value and fostering long-term advocacy for the platform. Technical Content Creation - Best Practices Develop practical, actionable high-quality technical content including Solution Guides, Reusable Sample Code, blog posts. Empower clients in overcoming technical challenges. Skills & Qualifications 7+ years in software engineering or solution architecture or sales engineer (or similar). Kubernetes 2+ years focused on Kubernetes or cloud-native platforms. Knowledge/understanding of Designing, Deploying & Managing AKS, EKS, GKE. Scripting Absolute comfort at the bash prompt. IaC expertise (Terraform). Python, Golang scripting proficiency. Understanding of Hybrid or multi-cloud architectures. Excellent communication skills, with an ability to convey technical solutions effectively to varied stakeholders. Bachelor's or Master's degree in Computer Science, Engineering, or related.
    $175k-200k yearly 3d ago
  • Nutritionist - HYBRID

    Unity Health Care 4.5company rating

    Washington, DC jobs

    Job Description INTRODUCTION Unity Health Care has launched a Food Pharmacy Program, a collaborative effort with Capitol Area Food Bank, to combat food insecurity for senior patients aged 65 years of age and older. The Food Pharmacy will target seniors who have hypertension, diabetes and/or obesity at Unity's East of the River health center site. Under the supervision of the Medical Director, the Nutritionist will provide patient nutrition education and consultation. Also, the nutritionist will determine and prioritize the nutritional risks of clients based on established priority factors. MAJOR DUTIES Provides nutritional instructions to patients 65+ living with hypertension, diabetes and/or obesity. Disseminates Unity-CAFB designed toolkit that promotes health education around healthy foods etc., Provides nutrition-based patient health education on tailored food prescription to address the patient's medical and nutritional needs, taking into consideration food preferences and cultural background. Develops nutritional care plans for designated high-risk individuals and provides follow-up instructions, as required, to assure that the health and nutritional needs of the clients are adequately addressed. Coordinates nutritional care with other health care members in order to ensure comprehensive medical and social services for clients, including referrals for related services, such as Food Stamps, Medicaid benefits, as required. Keeps abreast of current research findings in nutrition health education and related nutritional needs to assure that appropriate and up to date intervention strategies are provided to participants. Reviews patient's medical records for medical history, laboratory results in order to provide nutritional instructions and develop an appropriate and feasible meal plan. Participates in Food Pharmacy related meetings to provide ongoing patient progress/overall updates. Assures that nutrition education, patient engagement and counseling services are documented, as appropriate in the medical record. Performs other duties as assigned. QUALIFICATIONS Bachelor's of Science degree in Food and Nutrition required. Master's of Science in Food and Nutrition or related area preferred. Current Registered Dietitian DC License. Current Registered Dietician License preferred. Registered Dietitian with the American Dietetic Association. KNOWLEDGE & EXPERIENCE REQUIRED BY THE POSITION Bachelor's-level candidate must have minimum of two years of clinical experience. Master's candidate must have a minimum of one year of clinical experience, preferably in the area of infectious diseases. SUPERVISORY CONTROLS This position reports directly to the Medical Director, East of the River GUIDELINES This position abides by all rules and regulations set forth by applicable licensing and regulatory bodies, as well as UHC policies and Procedures. PERSONAL CONTACTS: This position has primary contact with the clients and employees of Unity Health Care. PHYSICAL DEMANDS Refer to attached ADA requirements. WORK ENVIRONMENT Refer to attached ADA requirements. OTHER SIGNIFICANT FACTS The incumbent must be able to balance the needs of diverse constituencies on a daily basis. RISKS The position involves everyday risk and discomfort, which require normal safety precautions typical of such places as offices, meetings, training rooms, and other UHC health Care Sites. The work area is adequately lit, heated, and ventilated. The position requires contact with staff at all levels throughout the organization. There are also external organizational relationships that may be a part of the work of this individual. All medical services shall be provided according to medically accepted community standards of care. The employee shall provide evidence of a recent (within the past twelve (12) months) health assessment that includes a PPD and/or chest x-ray results. The statements contained herein describe the scope of the responsibility and essential functions of this position but should not be considered to be an all-inclusive listing of work requirements. Individuals may perform other duties as assigned including work in other areas to cover absences or relief to equalize peak work periods or otherwise balance the workload.
    $50k-65k yearly est. 29d ago

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