MEDNAX Remote jobs

- 41 jobs

Agent Support Representative
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Agent Support Representative provides timely and effective sales support to Humana's selling agents. The Agent Support Representative will handle a high volume of inbound and possible outbound phone calls to assist insurance agents with pre-enrollment inquiries including the following: agent compliance (contracting, licensing, and certification), pre-enrollment inquiries, and agent commissions. **Where you Come In** **:** + Perform inbound and outbound calls from internal and external selling agents in a fast-paced call center. Assist agents with all pre-enrollment inquiries including compliance verification, enrollment, product, and processes. + Utilize documents, websites, and local networks to research and resolve inquiries of agents, involving Member enrollment and company products. + Leverage internal documentation and websites, along with online resources to investigate, guide, and support agents through pre-enrollment inquiries. + Build and strengthen relationships with both internal and external agents helping to build Humana's brand by providing a perfect agent experience. + Keep closely attuned to the needs and perspectives of agents and use these insights for the benefit of the business. **Required Work Schedule:** + **Virtual training will start day one of employment and runs for the first 4 weeks with a schedule of 10:00 AM - 6:30 PM EST, Monday - Friday. Five additional training sessions will follow. Attendance is vital for your success, so no time off is allowed during training (no exceptions). Training timelines are subject to change.** + **Must be in a secure, quiet place to work, free from any and all distractions, as it could interrupt your learning experience or agent's experience on the phone.** + **Following training, must be available to work any shift between the hours of 8:00 AM to 9:00 PM EST, Monday - Friday. Schedules are assigned based on business need, location, seniority and possibly attendance / performance. Associates will be taking inbound/outbound calls throughout the entirety of their day except for their scheduled breaks/lunches and any off-phone assignments approved by leadership.** + **Please expect overtime opportunities, both voluntary and mandatory, along with some weekends.** + **During the Annual Enrollment Period, which runs from October 15 - December 7, must have the ability to work between the hours of 8:00 AM to 9:00 PM EST, Monday through Saturday (and possibly Sunday), with the flexibility to work overtime based on business needs. Schedules are based on business needs, location, and seniority, and are subject to change. No time off will be allowed during the first 7 business days or the last 7 business days of AEP.** **Use your skills to make an impact** **Required Qualifications:** + **Minimum of 2 years** of demonstrated experience in delivering exceptional customer service, with a proven ability to build positive relationships and resolve inquiries effectively + Career-oriented individuals seeking long-term growth opportunities within the organization are strongly encouraged to apply + Excellent written and verbal communication skills, with the ability to confidently interact with internal teams and external partners in a professional manner + Proficiency in Microsoft Office Suite (Outlook, Word, PowerPoint, Teams, Excel) and Adobe Acrobat, including the ability to open, edit, and manage PDF documents + Strong general computer skills, including system navigation, accurate typing, basic troubleshooting, and initial computer setup + Ability to navigate multiple systems and applications simultaneously, utilizing search tools and resources to locate and process information efficiently + Demonstrated critical thinking, problem-solving, and emotional intelligence, with the ability to make sound decisions in a fast-paced environment + Commitment to remain within the department for a minimum of one (1) year, starting from the first day of employment + The pay for this position is $23.00 Per Hour **Preferred Qualifications:** + Associate or bachelor's degree + Prior leadership/supervisory experience + Bilingual in English and Spanish (potential increase in hourly rate for bilingual skills; see Additional Information below) **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 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 Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including: + Health benefits effective day 1 + Paid time off, holidays, volunteer time and jury duty pay + Recognition pay + 401(k) retirement savings plan with employer match + Tuition assistance + Scholarships for eligible dependents + Parental and caregiver leave + Employee charity matching program + Network Resource Groups (NRGs) + Career development opportunities **Our Hiring Process** As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you. If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker. 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. _*Please be advised, any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. Candidates must be tested in ALL languages listed on the description._ 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. $43,000 - $56,200 per year **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-16-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$43k-56.2k yearly Easy Apply 1d ago
Senior Acquisition Integration Professional
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Senior Acquisition Implementation Professional manages all aspects of Medicaid State Implementations, from start to finish, so that it is completed on time and within budget. The Senior Acquisition Implementation Professional works on problems of diverse scope and complexity ranging from moderate to substantial. This position provides the opportunity to lead/manage large cross-functional enterprise implementations that impact our members, providers, vendors, and internal stakeholders. The Senior Acquisition Implementation Professional manages all aspects of Medicaid State Implementation, from start to finish, so that it is completed on time and within budget. The Senior Acquisition Implementation Professional works on problems of diverse scope and complexity ranging from moderate to substantial. This position provides the opportunity to lead/manage large cross-functional enterprise implementations that impact our members, providers, vendors, and internal stakeholders. Responsibilities Include: + Designing, communicating, and executing implementation approach for Medicaid State Implementations. + Monitoring progress and performance for the implementation against the project plan; taking action to mitigate implementation issues and minimize delays. + Identifying, gathering, and onboarding the necessary resources to complete the project. + Communicating with operational areas to secure specialized resources and contributions for the project. + Conducting meetings and preparing presentations to communicate the status of the project. + Setting priorities, allocating tasks, and coordinating project staff to meet project targets and milestones. + Present implementation updates to steering committee and executive stakeholders. **Use your skills to make an impact** **Required Qualifications** + Minimum 5 years of Project Management experience + Minimum 5 years of experience delivering project, program, and portfolio management + Minimum 5 years of experience consulting/supporting large scale, strategic initiatives + Previous healthcare or managed care experience, preferably in the Medicaid space + Experience in an Agile environment + Proficient with MS Project, Lucid, PowerPoint, and Excel + Must be able to work Eastern Standard Time (EST) hours based on business need + Must be passionate about contributing to an organization focused on continuously improving consumer experiences + Ability to travel up to 10% based on business need within the US **Work-At-Home Requirements** + At minimum, a download speed of 25 mbps and an upload speed of 10 mbps is recommended; wireless, wired cable or DSL connection is suggested + Satellite, cellular and microwave connection can be used only if approved by leadership + Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **Preferred Qualifications** + PMP or Six Sigma Certifications + SCRUM Master Certified + SAFe 5+ Certified **Additional Information** + Ability to travel up to 10% based on business needs within the US + As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling, and Video technologies allow you to interact with us at the time and location most convenient for you. + If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. This is a remote role - #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. $94,900 - $130,500 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 03-30-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$94.9k-130.5k yearly 28d ago
Senior Content Strategy
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** Humana is evolving its marketing organization to better acquire and engage members through data-driven, technology-enabled, and personalized communications and the creative and content produced by the in-house agency team known as the Hive, is a vital part of this transformation. The **Senior Content** **Strategy** _(internally known as a Senior Professional, Creative Development)_ role will drive enterprise creative, marketing excellence, and enhance business value for Humana Inc. This position requires the experience and vision to inspire and develop marketing and creative strategies based on business objectives while building trusted relationships with our marketing partners. **Key Role Functions** + Build strong, cross-functional partnerships with the internal agency team, marketing partners, and external agencies + Drive creative strategy in support of Customer Lifecycle Marketing (CLM) + Oversee customer-centric campaign strategies and conceptual milestones. Leverage performance marketing expertise to deliver breakthrough creative that drives results. + Lead by example. Demonstrate and enable collaboration, constructive critique, and agile workflows + Understand the business, industry and competition, leveraging that knowledge to help generate new ideas to strategically grow business and marketing strategy + Ensure work is on-strategy and appropriate for the brand and the business + Consistently collaborate with team members throughout the work process to foster, facilitate and consistently deliver great work that is on strategy, on time, and on budget **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree + 5+ years of Marketing with a mastery of advertising fundamentals, including: branding, planning, positioning, strategy + 2+ years of advertising or internal agency experience + Ability to identify solutions that will generate measurable results + Independent self-starter and extremely detail-oriented + Able to present to Senior Leadership and influence decision makers + Ability to work well in a fast-paced team environment with an agile approach and iterative design process **Preferred Qualifications** + Master's Degree + Performance marketing **Additional Information** **This role is a 100% remote role anywhere in the US and will primarily operate on Eastern Standard Time business hours.** 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 Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including: + Health benefits effective day 1 + Paid time off, holidays, volunteer time and jury duty pay + Recognition pay + 401(k) retirement savings plan with employer match + Tuition assistance + Scholarships for eligible dependents + Parental and caregiver leave + Employee charity matching program + Network Resource Groups (NRGs) + Career development opportunities **Our Hiring Process** As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you. If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker. 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. $78,400 - $107,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-10-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$78.4k-107.8k yearly Easy Apply 4d ago
Special Needs Plan- Support Social Services
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Care Manager, Telephonic Behavioral Health 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Manager, Telephonic Behavioral Health 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Care Manager, Telephonic Behavioral Health 2 is a **Licensed, Masters level, Social Worker** who functions as a Support Social Services associate (Support SS) in our Special Needs Plan (SNP) program and serves as part of an interdisciplinary care team member working with other disciplines, such as nurse care managers, dieticians, behavioral health, and pharmacists to help promote and support member health and well-being. This role requires the use of structured assessments along with critical thinking skills to determine appropriate interventions such as care coordination, health education, connection to community resources, full utilization of benefits and advocacy. This role requires effective and professional communication with providers, community resources, and other members of the interdisciplinary team to address member needs. The Support SSs daily job duties include making outbound call attempts to members with social determinants of health (SDOH) needs to assess and assist with coordinating care with available plan benefits and/or appropriate community resources in a telephonic, call center, work from home environment. This role does not carry a caseload but may require additional member follow-up to ensure that all needs have been assessed and addressed. The Support SS may also receive inbound calls from members needing additional assistance. This role is also responsible for assessing the member to determine if a referral to any other discipline is needed depending on member's individualized needs. Creating and updating member care plans may be required. Documentation in the member's record is required to ensure CMS compliance, and accurately reflect work with members, providers, and other members of the interdisciplinary care team. **Use your skills to make an impact** **Required Qualifications** + Master's degree in social work from an accredited university + Current, unincumbered, social work license; **LMSW, LCSW, LICSW** + Must have passed ASWB Exam (Master, Advance Generalist, or Clinical level) + Minimum 3 years of experience working as a social worker in a medical healthcare setting + Proficient in Microsoft applications including Word, Outlook, Excel + Capacity to manage multiple or competing priorities including use of multiple computer applications simultaneously + Must be willing to obtain/maintain social work licensure in multiple states, based on business need **Preferred Qualifications** + Experience working with geriatric, vulnerable, and/or low-income populations + Licensure in LA, MD, MI, MS, NV, NM, OK, VA + Bilingual English/Spanish + Bilingual English/Creole + Experience working with Medicare and Medicaid **Additional Information** **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. **Social Security Notification:** 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. **HireVue Interview Process:** 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. **Benefits Day 1:** Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including: Health benefits effective day 1 Paid time off, holidays, volunteer time and jury duty pay Recognition pay 401(k) retirement savings plan with employer match Tuition assistance Scholarships for eligible dependents Parental and caregiver leave Employee charity matching program Network Resource Groups (NRGs) Career development opportunities **START DATE after completion of background/onboarding-** *Projected start dates for these positions will be throughout Feb 2026 with all interviews being conducted Dec/Jan **Schedule:** + Hours for this position are Monday - Friday 9:30am - 6pm EST. + Hours for the first 2 weeks of training are M-F 8:30am-5pm EST Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $59,300 - $80,900 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-21-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$59.3k-80.9k yearly Easy Apply 37d ago
Value Based Programs Lead
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Value-Based Programs Lead supports successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. The Value-Based Programs Lead provides strategic advice and guidance to functional team(s). Highly skilled with broad, advanced technical experience. The Value-Based Programs Lead works with senior executives to develop and drive segment or enterprise-wide functional strategies with key national value-based provider partners. Advises one or more areas, programs or functions and provides recommendations to senior executives on matters of significance, and as an advanced subject matter expert, competent to work at very high levels in multiple knowledge and functional areas across the enterprise. + Advises market executives to develop functional strategies on matters of significance for provider contracting and performance management + Consults and leads the internal and external provider engagement strategy + Leads national joint operating committee with internal and external leadership + Possess a solid understanding of how organization capabilities interrelate across department(s) **Use your skills to make an impact** **Required Qualifications** + 3+ years of experience with provider performance management and/or value-based contracting + Strong understanding of key value-based financial components including revenue drivers, expense (DOFR) components, benefit and sales process. + Experience working with senior leadership + Experience facilitating cross departmental projects + Strong communication and presentation skills, including experience developing polished presentations to influence key decision makers + Strong project management experience on mid to large scale projects + Flexible, dynamic personality who works well in a team environment **Preferred Qualifications** + Provider contracting and/or provider relations experience + Working knowledge of Service Fund reports + Advanced Degree (Bachelor's, Master's) + Experience with data extraction and analysis technologies + Experience preparing contracts and knowledge of Medicare and other reimbursement methodologies + Financial acumen with proficiency in analyzing and synthesizing provider financial trends into actionable insights + Solid experience building templates, standard documentation, and disseminating best in class knowledge **Additional Information** This role is "remote/work at home" and can be based anywhere in the United States. **Work at Home 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. + 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. $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: 12-11-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$104k-143k yearly 8d ago
Medicaid Provider Hospital Reimbursement Methodologies Analyst
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be an integral part of the Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing Medicaid business and expansion into new states. The business needs of the team continue to evolve and grow, changing the composition of the team as it expands to accommodate the increased responsibilities. The Senior Business Intelligence Engineer will be primarily responsible for implementation, maintenance and support of Medicaid provider reimbursement for hospitals and facilities. They will work closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid business at Humana. The Senior Business Intelligence Engineer will develop and maintain expertise in Medicaid reimbursement methodologies rooted in complex grouping concepts (EAPG, APR-DRG, MS-DRG, etc). This role is within the Integrated Network Payment Solutions (INPS) department which falls under the Provider Process and Network Organization (PPNO). The Senior Business Intelligence Engineer will be responsible for: Researching state-specific Medicaid reimbursement methodologies for hospitals and facilities Developing expertise in complex groupers (EAPG, APR-DRG, MS-DRG, etc) utilized in Medicaid reimbursement Reviewing Medicaid RFPs and state contracts to identify provider reimbursement requirements Supporting implementation of new Medicaid pricers including: + Reviewing pricing software vendor specifications. + Identifying system changes needed to accommodate state-specific logic. + Assisting with requirements development; and + Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root causes driving issues and developing solutions + Working closely with IT and pricing software vendor to resolve issues + Developing Policies & Procedures + Identifying automation and improvement opportunities + Researching and resolving provider reimbursement inquiries **Use your skills to make an impact** **Required Qualifications** + 3+ years of experience researching state Medicaid hospital reimbursement methodologies that utilize MS-DRG, APR-DRG, APC or EAPG + 2+ years of experience with Optum Rate Manager + 2+ years of experience with Optum WebStrat or PSI applications + Experience reviewing facility claims + Prior professional experience utilizing Microsoft Excel (e.g. performing basic data analysis and utilizing pivot tables or various formulas or functions such as VLOOKUP) **Preferred Qualifications** + Experience researching and resolving provider reimbursement inquiries + Experience researching MS-DRG, APR-DRG and/or EAPG grouper logic + Experience interacting with a State Medicaid or Federal government agency + Intermediate Microsoft Access skills **Additional Information** This role is "remote/work at home" and can be based anywhere in the United States **Work at Home 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. + 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. $89,000 - $121,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-15-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$89k-121.4k yearly 53d ago
Stars Technology Business Intelligence Lead Product Owner
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Lead, Technical Product Owner requires someone known for creative problem solving. This role solves complex business problems and issues using data and custom software from internal and external sources. The role works on problems of diverse scope and complexity ranging from moderate to substantial. It is responsible for leading, defining and delivering on the roadmap of multiple data and business application products. This role bridges product ownership, data and software engineering, and regulatory healthcare data requirements, ensuring that data ingestion, transformation, and delivery are optimized for quality measurement, reporting, and compliance with CMS standards. We are seeking an individual with a growth mindset, who is a highly experienced Technical Product Owner to drive the development of data products specifically related to CMS Stars and HEDIS quality measures. The ideal candidate has deep expertise in Stars/HEDIS data, regulatory requirements, and agile product development, and 3 tier software development and technical support for critical systems. In this role, you will teach and collaborate with business stakeholders, data engineers, and IT teams to translate complex requirements into actionable product features that support quality measurement, reporting, and compliance. **Key responsibilities:** + **Technology strategy and roadmap of Business and Data Products:** Define and maintain the vision, strategy, and roadmap for data products that enable CMS Stars and HEDIS reporting. Ensure alignment with enterprise goals and departmental priorities. + **Backlog management:** Own, groom, and prioritize the product backlog for one or more agile teams, ensuring it reflects business needs, regulatory changes, and technical dependencies. + **Requirements translation:** Elicit detailed requirements from stakeholders (e.g., business, compliance, and analytics) and translate them into clear user stories with defined acceptance criteria for development teams. + **Cross-functional collaboration:** Act as the primary liaison between business stakeholders and technical teams. Facilitate communication and alignment across data engineering, analytics, compliance, and QA teams. + **Technical guidance:** Work closely with data architects and engineers to design and validate data flows, mappings, and transformations. Provide guidance to ensure technical solutions are feasible and aligned with the product vision. + **Data quality and compliance:** Collaborate with governance teams to establish data quality benchmarks and implement testing protocols. Ensure data products adhere to CMS mandates and NCQA standards. + **Technical debt management:** Advocate for the resolution of technical debt and architectural improvements, balancing short-term feature delivery with long-term product sustainability. + **Stay current:** Monitor evolving CMS, NCQA, and HEDIS requirements and coordinate necessary updates in response to specification changes. + **Travel for this role is quarterly** **Use your skills to make an impact** **Role Essentials** + Bachelor's degree + 8 or more years of experience in data flow & analysis and software application building & enhancements + 2 or more years of project leadership experience + Strong experience with healthcare data, particularly clinical and claims data used in **HEDIS measurement** + Familiarity with **CMS Stars programs** , NCQA standards, and quality performance metrics. + Advanced experience working with big and complex data sets within large organizations + Experience analyzing data to solve a wide variety of business problems and create data visualizations that drive strategic direction + Proven ability to work with cross-functional teams and translate requirements between business, project management and technical projects or programs + Proficiency in understanding Healthcare related data + Proficiency in verbal/written communication to senior and executive leadership **Role Desirables** + Advanced Degree in a quantitative discipline, such as Mathematics, Economics, + Finance, Statistics, Computer Science, Engineering or related field + Knowledge of NCQA, CMS, and health plan quality measurement programs. + Deep understanding of healthcare interoperability standards (e.g., HL7, FHIR, X12). + Advanced in SQL, SAS and other data systems + Expertise in data mining, forecasting, simulation, and/or predictive modeling + Experience creating analytics solutions for various healthcare sectors **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. 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. 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 you. 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. $117,600 - $161,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-09-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$117.6k-161.7k yearly Easy Apply 42d ago
Learning Design Lead - AI
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The AI Learning Design Lead plays a critical role in designing, developing, and delivering strategic learning experiences that support Human's AI initiatives. This role operates with a high degree of independence and collaborates across teams to ensure alignment between business goals and learning outcomes. The Learning Design Lead analyzes content, organizes content, designs solutions, and writes storyboards, scripts, performance support, mobile learning and manuals. Analyzes learning needs and partners with subject matter experts to provide input for course content. Writes effective learning objectives and coordinates performance assessments to measure training effectiveness. Ensures 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 use social media and collaborative tools to facilitate learning. Plans, organizes, and develops 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. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action. **Use your skills to make an impact** **Program Leadership & Stakeholder Engagement** **:** + Serves as the primary point of contact for all AI Learning Program stakeholders, including executives, HR, and external partners + Partners with the Associate Director to represent the program in executive forums, to define and provide updates on roadmap, measurement rubrics, learning prioritization, and scaling strategies. + Partners with the appropriate communicationspersonnel to deliver program -related communication(s) to the relevant stakeholders + Develop program timelines including milestones and KPIs to regularly report progress to stakeholders + Lead and develop a high-performing team, including both direct and indirect reports, fostering collaboration, accountability, and alignment with organizational goals. **Operations & Vendor Management** **:** + Respond to inquiries from the AI learning mailbox, ensuring timely and professional communication. + Manage vendor relationships to ensure our program has what it needs to succeed **Budget & Reporting:** + Own the full lifecycle of the AI Learning program budget, from creation to tracking and burn management. + Lead all reporting efforts, including project plans, OKRs, executive reporting, including dashboards, and Steering Committee updates **Event Management:** + Oversee the planning and execution of all AI Learning events, ensuring high-quality experiences that reflect the program's values. + Coordinate with supporting teams while maintaining accountability for successful delivery. **Documentation and Governance:** + Maintain strong documentation practices to ensure transparency, continuity, and informed decision-making. + Develop and manage program governance materials, including committee operating guidance and program documentation + Coordinate with supporting people and teams while maintaining accountability for successful delivery. **Required Qualifications:** + Bachelor's degree ininstructional design, learning design or similar (or equivalent work experience). + 4+ years of experience in leading corporate learningprograms. + 2+ years of experience leading corporate AI or emerging technology training. + Proven experience managing cross-functional projects with executive visibility. + Experience owning and managing program budgets, including forecasting and tracking spend. + Exceptional written and verbal communication skills, with the ability to engage and influence executive stakeholders. + Experience leading communications across multiple stakeholder groups, including HR, leadership, and external vendors. + Comfortable serving as the face of a program and representing it in high-visibility forums. + Proven ability to plan and execute high-impact events with attention to detail and participant experience. + Strong organizational skills with the ability to manage multiple priorities and deadlines. + Demonstrated excellence in documentation practices, including maintaining clear, consistent, and accessible program records. + Proficiency in creating and managing reports for diverse audiences (e.g., OKRs, project plans, executive summaries, steering committee updates). + Proficiency with productivity and collaboration tools (e.g., Microsoft Office Suite, especially PowerPoint) , SharePoint, Teams **Preferred Qualifications:** + Program management (PgMP) or project management (CAPM, PMP) Certifications + Learning development certification (APTD or CPTD, Bob Pike, etc.) + Experience in IT, health care, or insurance environments + Familiarity with project management tools (e.g., Planner,JIRA Align, MS Project or similar platforms) is a plus. **Additional Information:** Qualified candidates are required to live within commutable distance for a hybrid (~3 days in-office) work arrangement. **_Preferred locations are:_** _- Washington, D.C. metropolitan area_ _- Louisville, KY metropolitan area_ _- Denver, CO metropolitan area_ _- Dallas, TX metropolitan area_ _- Ft. Lauderdale, FL metropolitan area_ Some travel may be required based upon candidates' location. Travel anticipated not to exceed 20%. 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. $94,900 - $130,500 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-11-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$94.9k-130.5k yearly 4d ago
Senior Cloud Solutions Engineer
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Senior Cloud Solutions Engineer participates in the design and development of cloud-based solutions and applications in the big data space within Humana's Digital & Data organization primarily using Microsoft Azure and related technologies. The Senior Cloud Solutions Engineer work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Cloud Solutions Engineer implements the organization's cloud strategy from a technical perspective, including design, planning, integration, and maintenance for big data solutions using Microsoft Azure. This will involve participating in the design and development of cloud-based solutions and applications within Humana's Digital & Data organization primarily using Microsoft Azure. Responsibilities Include: + Work with stakeholders across organization to evaluate cloud systems and identify appropriate solutions. + Collaborates with product managers and engineers to develop specifications for new cloud-based products/services, applications and solutions. + Drives the roll-out of cloud management platforms, evaluates its performance and implements enhancements. Begins to influence department's strategy. + Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree in Computer Science, a related field, or equivalent professional experience. + Proven experience designing and implementing cloud-based big data solutions using Azure, AWS, or GCP. + Minimum of 6 years of experience in cloud application design, development, and testing. + At least 3 years of hands-on experience working with Databricks, Azure Data Factory, and Azure Synapse Analytics. + Proficient in ETL processes, SQL, and PySpark for data integration and transformation tasks. + Experience with version control systems (such as Git) and managing release pipelines. + Demonstrated commitment to enhancing consumer experiences and supporting continuous organizational improvement. + One or more professional certifications in Azure, Databricks, or other major cloud platforms. **Preferred Qualifications** + Master's Degree + Databricks experience + Python experience **Work-At-Home Requirements** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested + Satellite, cellular and microwave connection can be used only if approved by leadership + Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $106,900 - $147,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-18-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$106.9k-147k yearly 60d+ ago
Senior Coding Educator
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Senior Coding Educator will work closely with providers to identify documentation and coding improvement opportunities and give guidance around operational and clinical best practices in the risk adjustment methodology. This role reports to the Risk Adjustment Manager and will work closely with market operations, finance, and clinical team to effectively influence a provider to adopt best practices in the risk adjustment methodology. The successful candidate will possess extensive, in-depth and broad knowledge of the HCC risk adjustment methodology gained from actual experience of chronic condition documentation and coding audits, risk adjustment program implementation and provider education delivery. An ideal candidate will also have the ability to look at provider performance metrics and be able identify where the risk adjustment gaps exist and how to close them with available resources by putting together an action plan. This also requires a commitment to cultivating internal and external business relationships to achieve desired outcomes. + Develop a comprehensive understanding of Humana's risk adjustment programs and the resources required for successful implementation. + Develop and apply keen insight of our providers and our KPIs, and be able to strategically assess where improvements can be made in the most effective way with available resources. + Perform analysis of performance indicators and put together a formal presentation for reporting out to providers on a regularly scheduled basis. + Provide measurable, actionable solutions to providers that will result in improved accuracy of documentation and coding, and adoption of best practices. + Successfully implement identified course of action to effectively impact risk adjustment deadlines and report on progress regularly. + Assist providers in understanding the CMS - HCC Risk Adjustment program as a payment methodology and the importance of proper chart documentation. + Knowledge of EMR interoperability solutions to influence provider groups in population health management through Point of Care Alerts and Supplemental Data (i.e. preferably Epic, Athena and eCW). + Facilitate presentations and train physicians and other staff regarding documentation, billing and ICD10 coding, and provide feedback to physicians regarding documentation practices and compliance with state and federal regulations. + Cultivate effective partnerships in a matrix environment of coding educators, medical director, clinical and market operations. + Facilitate, track and trend for reporting to leadership and participating groups and be able to make recommendations for improvement. **Use your skills to make an impact** **Required Qualifications** + 5+ years of experience in risk adjustment coding/auditing/education and provider relations/engagement + Certified Professional Coder (CPC) + Prior experience in successfully engaging with providers to participate in performance improvement programs + In-depth knowledge of risk adjustment key performance indicators and CMS payment models (V24 and V28) + Prior experience working in a cross-functional team + Expert facilitation and presentation skills to include online delivery + Advanced Microsoft Office skills including Word, Excel, Outlook and PowerPoint + Advanced knowledge of billing / claims submission and other related functions + Demonstrated ability to manage competing priorities and to effectively manage projects simultaneously + Demonstrated ability to adapt quickly to change **Preferred Qualifications** + Bachelor's Degree + Certified Risk Adjustment Coder (CRC) + Certified Documentation Expert Outpatient (CDEO) + Knowledge of EMR (Athena, Epic and eCW) + Experience gained in risk adjustment field in physician practice or provider group + Review reports and analyze data to identify areas of improvement opportunities for provider groups **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/Internet 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. + 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 **SSN Information:** 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. $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 Easy Apply 9d ago
Behavioral Health Care Manager
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Behavioral Health Care Manager, in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and well being of members. The Behavioral Health Care Manager's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Behavioral Health Care Manager + Supports Humana member's access to behavioral health services, including a focus on the increased need in behavioral health services + Provide member outreach and education related to behavioral health including assessing risk, determining appropriate care in individual patient communities, and collaborating with providers as well as clinicians across other Humana departments + Employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues + Identifies and resolves barriers that hinder effective care + Ensures member is progressing towards desired outcomes by continuously monitoring member care through assessments and/or evaluations + May create member care plans + Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas + Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed + Follows established guidelines/procedures Schedule will require an 8 hour shift between 8:00 AM and 6:00 PM in your local time zone. Occasional overtime may be requested as business needs. **Use your skills to make an impact** **Required Qualifications** + Current valid social service license, e.g. MSW, LCSW, LPC, LMHC + Master's degree in a behavioral-health field, such as social work, counseling, or related health discipline from an accredited university + 2+ years in an integrated care setting managing members with both Behavioral Health needs and/or Substance Use such as crisis experience (includes ER), community mental health center, behavioral health inpatient, assertive community treatment, etc + Experience with behavioral change, health promotion, coaching and/or wellness + Proficiency utilizing software programs, (e.g., Word, Excel & PowerPoint & shared systems) troubleshoot and resolve general technical issues **Preferred Qualifications** + Bilingual (English/Spanish), with ability to pass a Language Proficiency Assessment + Experience supporting patients telephonically + Experience working in Community Mental Health or as part of a crisis response team or Assertive Community Treatment (ACT) team, and substance use disorder treatment + Experience working with both children and adults **Additional Information** 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. Language Assessment Information Any Humana employee who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $59,300 - $80,900 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-18-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$59.3k-80.9k yearly 8d ago
Staff Utilization Management Clinical Pharmacist
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying evidence-based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors. **_Earn a $5,000 hiring bonus!_** **Bonus is paid after 180 days of employment; you must be employed until that date to be eligible to receive the payment."** **Location:** **Remote - United States** **Schedule:** + 8-hour shifts, Monday through Friday, between 10:30 AM and 11:00 PM EST **OR** + 10-hour shifts, Tuesday through Friday, between 10:30 AM and 11:00 PM EST + Required to work **every 5th Saturday** + Required to work **1 company holiday per calendar year** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization, and identifying unusual usage patterns. The pharmacist may intervene and provide clinical guidance to patients and providers to support cost-effective medication use and promote high-quality patient outcomes. **Use your skills to make an impact** **Required Qualifications:** + **Bachelor's degree or Doctor of Pharmacy (Pharm.D.) from an accredited college of pharmacy** + Active pharmacist license in the state of residence + Eligibility to participate in federal prescription programs (e.g., Medicare/Medicaid) + Self-directed with the ability to work effectively both independently and in a team environment + Strong problem-solving skills and the ability to foster collaborative solutions + High attention to detail with a strong work ethic focused on accuracy and productivity + Excellent verbal and written communication skills + Proficiency with computer systems, including but not limited to: + Microsoft Office Suite (Word, Excel, Outlook) + Clinical decision support tools (e.g., Micromedex, Lexicomp) + Pharmacy benefit management (PBM) platforms + Electronic health records (EHRs) + Passion for contributing to an organization focused on continuously improving the consumer experience **Preferred Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **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 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. **SSN Statement:** 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. $94,900 - $130,500 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-12-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$94.9k-130.5k yearly Easy Apply 9d ago
Technology Solution Implementation Professional
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Technology Solution Implementation Professional delivers new technological solutions to meet business needs within a specified scope while aligned to enterprise objectives. The Technology Solution Implementation Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. **Role Description:** Support Medicaid Implementations and Operations in electronic transmissions set-up for state regulatory partners, health information exchanges, and vendor partners. **Responsibilities:** Works with ETL developers, data stewards, project managers, and business SMEs to obtain programming specifications needed to submit information in our proprietary ticketing system that moves data from its origin to its ultimate destination. + Ensures proper documentation is completed so that the programming and testing occurs + Tracks and maintains documentation on ET work + Communicates between both IT and non-IT departments on updates, as well as educating non-IT departments on the process + Ensures proper access for authorized users and provides support to data tool users + Conducts connectivity testing when needed + Coordinates establishing connections to SFTP sites in collaboration with the State Technology Market Lead + Coordinates resolution of resolving ETL issues for the market + Participates on vendor and market calls when necessary + Produces reports and analytics outlining progress and resolution + Maintains inventory of market ET transmissions + Other duties as assigned **Use your skills to make an impact** **Required Qualifications** + Two years + experience using technology in data analysis projects or in projects that dealt with business data flows. + 1 + years of ETL experience. + Demonstrated understanding of the information needs and processing flows in healthcare environments + Experience with the SDLC phases of a project and general knowledge of project management. + Demonstrated excellent written and verbal communication skills. + Demonstrated ability to maintain confidentiality, follow directions, and use good judgment in an environment that can be ambiguous and time sensitive. + Ability to work EST + SFTP Experience + Process Improvement **Preferred Qualifications:** + Power BI, Jira and ADO training preferred + Experience with Agile Methodology and/ or Scaled Agile Methodology + Experienced in introducing new processes into a new or existing environment while minimizing disruption and mitigating risks + Experience with Medicare and/or Medicaid + Ability to coordinate with development and user teams to assess risks, goals, and needs and ensure that all are adequately addressed + Bachelor's degree in CS, Engineering, Math, Information Systems, Data Science, Data Analytics, or Statistics **Additonal Information** Candidates should be prepared to work outside regular hours when required to meet essential timelines. 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 informatio 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. $60,800 - $82,900 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-14-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$60.8k-82.9k yearly 21d ago
Medical/Financial Risk Evaluation Professional 2
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Medical/Financial Risk Evaluation Professional 2 is responsible for supporting the development, implementation and monitoring of medical/financial risk. The Medical/Financial Risk Evaluation Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Medical/Financial Risk Evaluation Professional 2 identifies, assesses, and mitigates any medical or financial risk that arises from inadequate or failed processes, people, systems, or external events. Maintains a balance between risk mitigation and efficiency. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree + Experience with identifying and/or reporting fraud, waste and abuse within the healthcare industry + Knowledge of the Medicare and Medicaid programs + Experience in data analysis + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + 2 years of Humana Experience + Knowledge of Humana Medical and Pharmacy Claims Processing Systems + Experience with data query/data programming applications (i.e SQL, Python) + Knowledge of data visualization tools (i.e. Power BI, QlikView, Tableau) **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. 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. $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: 12-14-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$65k-88.6k yearly 4d ago
Principal, Stars Enterprise Activation - Insurance Operations
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Stars Enterprise Activation Principal coordinates, implements, and manages oversight of the company's Medicare/Medicaid Stars Program for aligned areas. The Stars Improvement Principal provides strategic advice and guidance to functional team(s). Highly skilled with broad, advanced technical experience. This role is responsible for supporting the Stars strategy within Insurance Operations, serving as a subject matter expert for Stars-related initiatives, and ensuring their effective activation and integration throughout the Insurance Operations organization. Insurance Operations encompasses critical functions including care coordination, quality measurement, billing, claims processing, and customer service, each essential to delivering a comprehensive and high-quality member experience. In this role, you will identify and engage with each area under Insurance Operations that has Stars-related initiatives to understand the business strategy, scope, and goals, building a working knowledge to inform identification and validation of potential synergies, business-specific requirements, risks, and integration paths. This role will collaborate with key Stars and segment business partners to monitor existing work, gain alignment on cross-asset integration opportunities, identify and implement new initiatives, and measure the value of the work. In addition, this role will support the inventory of existing Stars initiatives and help to identify gaps and opportunities for greater collaboration across segments. This role requires a deep understanding of operations and how it connects with enterprise Stars governance and initiatives. **Role Responsibilities:** + Oversight of related budget, vendor relationships, and program/ project management + Serve as the primary liaison for Stars initiatives within Insurance Operations, building deep operational knowledge of core functional areas (care coordination, quality, billing, claims, and customer service). + Collaborate with each Insurance Operations function to identify, understand, and align Stars-related business strategies, objectives, and operational requirements. + Evaluate business processes across Insurance Operations to identify synergies, integration opportunities, and operational risks related to Stars performance and compliance. + Coordinate with analytics and reporting teams to generate actionable insights, enabling data-driven prioritization of operational improvements that directly impact Stars measures. + Partner with segment and enterprise Stars leaders to advance cross-functional initiatives, ensuring alignment between operational execution and Stars strategy. + Maintain a comprehensive inventory of Stars initiatives within Insurance Operations, identifying gaps and facilitating collaboration to maximize impact across all operational areas. + Lead and support the design, implementation, and optimization of Stars-related programs and processes within Insurance Operations, including performance monitoring and continuous improvement. + Oversee test-and-learn pilots to validate solutions and measure operational effectiveness, using results to inform broader implementation. + Develop and deliver regular reports on Stars operational performance to executive leadership, providing clear visibility into progress, challenges, and opportunities. + Manage budgets, vendor relationships, and project plans to support the successful delivery of Stars-focused operational initiatives. **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree + 8-9 + years of quality improvement, developing & advancing enterprise strategy, insurance operations experience, i.e.: claims, UM, CM, call center, enrollment, etc. + 5 years or more of CMS Stars program experience + Medicare Advantage experience + Previous leadership experience as a people leader, leading through influence, or leading complex projects with engagement from multiple areas of the company + Demonstrated track record of ability to tell the story, influence leaders and drive improvement activity in a matrixed organization + Strong executive presence + Ability to navigate business intelligence tools to review data insights & making data driven decisions + Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint **Preferred Qualifications** + Master's Degree **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 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 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. 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. $138,900 - $191,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-18-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$138.9k-191k yearly Easy Apply 23d ago
Senior Value-Based Programs Reporting Analyst
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Senior Value-Based Programs Reporting Analyst builds templates, standard documentation, policy and protocol, and disseminates best in class knowledge concerning Humana's Physician Recognition programs. The Senior Value-Based Programs Reporting Analyst's work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. This position serves as a subject matter expert for Humana's strategies supporting physician practice evolution and movement along the value-based continuum. Associate will make decisions on moderately complex to complex issues regarding technical approach for project components, and work is often performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Position will serve as a subject matter expert (SME) for the creation and implementation of Humana's Primary Care Physician Recognition programs, including Model Practice, Patient-Centered Medical Home, and Quality Recognition programs across multiple lines of business (Medicare and Medicaid). + Utilizes complex SQL, SAS, and other technical skills to drive process improvement and assist markets in managing their value-based relationships + Works cross-functionally with various other departments in order to source and aggregate data elements for program administration and reporting + Creates the data infrastructure that supports various downstream departmental processes, including provider contract review and interpretation and maintenance of participation table processes + Serves as a primary technical subject matter expert for department processes and the creation of program reporting + Creates process documentation for both existing and new program reporting using tools including, but not limited to, PowerBI, PowerApps and SAS/SQL In addition to being a great place to work, Humana also offers industry leading benefits for all employees, starting your FIRST day of employment. Benefits include: + Medical Benefits + Dental Benefits + Vision Benefits + Health Savings Accounts + Flex Spending Accounts + Life Insurance + 401(k) + PTO including 9 paid holidays, one personal holiday, one day of volunteer time off, 23 days of annual PTO, parental leave, caregiving leave, and weekly well-being time + And more **Use your skills to make an impact** ** Required Qualifications** + ** ** 5+ years' experience with Data Analytics and Reporting Tools (SQL, SSRS, Python, and/or SAS) + 3+ years' Healthcare provider data experience + Advanced knowledge of MS Excel (pivot tables, vlookups, formulas, etc.) + Experience working with large data sets and garnering insights + Strong written and verbal communication skills + Ability to grasp complex subjects and work independently to devise creative solutions + Individual initiative and desire to grow ** ** **Preferred Qualifications** + Bachelor's Degree (Preferably in Finance, Business Administration, or Computer Information Systems) + Experience working with data visualization tools (e.g. PowerBI or other) + Databricks experience + Project Management Experience + Advanced Knowledge of Humana's Data Infrastructure **Additional Information** **_You must be authorized to work in the US without Humana sponsorship as Humana does not provide work visa sponsorship for this role._** Work at Home/Remote Requirements **Work-At-Home Requirements** + To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended to support Humana applications, per associate. + Wireless, Wired Cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if they provide an optimal connection for associates. The use of these methods must be approved by leadership. (See Wireless, Wired Cable or DSL Connection in Exceptions, Section 7.0 in this policy.) + Humana will not pay for or reimburse Home or Hybrid Home/Office associates for any portion of the cost of their self-provided internet service, with the exception of associates who live or work from Home in the state of California, Illinois, Montana, or South Dakota. Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **Our Hiring Process** As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you. If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker. \#LI-LM1 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $78,400 - $107,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-12-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$78.4k-107.8k yearly 3d ago
RN Care Manager - Remote, nationwide
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. **The first 4 weeks of training will be from 8:30AM to 5:00PM EST. No time off is permitted during the first month of training.** **Following training, the start time is 10:00AM EST.** Our nurses are titled Care Managers, because our case management services are centered on the person rather than the condition. We contact members with multiple chronic conditions as well as financial and functional barriers in order to assist them in achieving and maintaining optimum health. We provide telephonic outreach to assess and support their health, offering education, identifying resources, and helping remove barriers to achieving health and independence, while using a multidisciplinary team. This position will be part of our Special Needs Program (SNP) team. All of our SNP RN Care Managers are work at home associates, working from a dedicated home office space. Work at home care managers are responsible for meeting quality and productivity measures daily and maintaining working home internet at all time with demonstrated advanced communication and interpersonal skills. This is a very compliance driven and highly visible program at Humana. The nature of the work requires telephonic interaction with members during the majority of the business day, primarily through an auto dialer system. Environment is fast paced and requires ability to engage quickly with member while concurrently navigating multiple computer applications. Due to the auto dialer process and compliance needs of the business there is limited day to day flexibility in care manager's schedule. **Duties:** + Telephonically assess Medicare, Medicaid, and/or and Group Account members and create actionable and measurable care plans to help guide and track the members' progress toward goals + Use nursing judgment to assess and coordinate care for acute situations (APS, EMS) + Discuss transitions of care to assist with safe discharge to the home and coordinate care for DME, home health, provider appointments, etc. + Guide members and their families toward and facilitate interaction with resources appropriate for the care and wellbeing of members + Assess member's physical, environmental and psycho-social health issues and work in collaboration with a multi-disciplinary team, such as social workers, dietitians, pharmacists, etc., employing a variety of strategies/techniques to manage appropriately and provide timely intervention **Use your skills to make an impact** **Required Qualifications** + Active Registered Nurse (R.N.) license with no disciplinary action. + **Hold an active Compact nursing license and** **reside in the state that holds your compact license.** + The National Council of State Boards of Nursing (NCSBN) developed the Nursing Licensure Compact (NLC), which is an agreement between states that allows nurses to have one license and the ability to practice in all the states that participate in the program. License must be current with no disciplinary action. + Minimum education of an Associates degree in Nursing. + Seasoned RN with a **minimum of 3 years of clinical nursing experience.** + Demonstrated clinical knowledge and expertise as evidenced by providing intervention to manage variety chronic conditions, including development and implementation of individualized care planning. + Intermediate to advanced computer skills as evidenced by ability to navigate multiple systems, utilizing dual computer monitors. + Provide autonomous decision-making, troubleshooting and problem solving related to periodic system issues. + Experience with Microsoft and Excel + Ability to quickly learn and navigate software programs and applications. + Capacity to manage multiple or competing priorities including use of multiple computer applications simultaneously. + Effective communication and interpersonal skills. + Effective problem solving and appropriate application of clinical knowledge + Must have a separate room with a locked door that can be used as a home-office to ensure you and your members have absolute and continuous privacy while you work. + Must possess advanced telephonic and virtual communication skills. **Preferred Qualifications** + BSN or MSN degree in nursing or equivalent + Previous adult chronic conditions care management + Previous experience in care management including knowledge of complex care management and care management principles + Experience with motivational interviewing + Experience with MCG or CMS guidelines, assessment and documentation practice + Case Management certification (CCM) + Bilingual in English and Spanish **Work-At-Home Requirements** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: + You must provide your own HARD WIRED high-speed internet. Satellite is not allowed for this position + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended + Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **Additional Information - 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 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 60d+ ago
Senior Provider Contracting Professional
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Senior Provider Contracting Professional work assignments involve moderately complex issues where the analysis of situations may be required. The Senior Provider Contracting Professional communicates contract terms, payment structures, and reimbursement rates to providers. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Begins to influence department's strategy. Makes decisions on moderately complex issues regarding technical approach for project components, and work is performed with minor direction. Exercises considerable latitude in determining objectives and approaches to assignments. **Use your skills to make an impact** **Required Qualifications** + Bachelor's Degree + 5 or more years of progressive network management experience including hospital contracting and network administration in a healthcare company + Experienced in negotiating managed care contracts with large physician groups, ancillary providers and hospital systems + Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers + Demonstrated ability to articulate ideas effectively in both written and oral forms + Ability to manage multiple priorities in a fast-paced environment + Proficiency in MS Office applications **Preferred Qualifications** + Experience contracting for Medicaid in Washington state + Master's Degree + Experience with ACO/Risk Contracting + Experience with Value Based Contracting **Additional Information** **Work at Home / Internet 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 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 **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. $78,400 - $107,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$78.4k-107.8k yearly Easy Apply 10d ago
Pharmacy Director
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The Clinical Pharmacist Lead monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, and/or implement strategies and programs to mitigate cost trend and improve health outcomes. The Clinical Pharmacist Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Pharmacy Director, internally known as a Clinical Pharmacy Lead, plans, directs, and monitors all financial, operational, professional, and clinical activities for the purposes of pharmacy program development for our Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual leverages a broad understanding of managed care and pharmacy benefit management (PBM) to develop and implement strategies and programs that mitigate cost trends and improve health outcomes. They ensure the pharmacy department provides optimal pharmaceutical services that meet all legal, accreditation, and certification requirements. This position will coordinate day-to-day pharmacy operations directly with the plan Chief Executive Officer and Chief Medical Officer. POSITION RESPONSIBILITIES: + Keeps current with State and Federal regulations regarding the practice of Pharmacy and implements changes as necessary to maintain compliance supporting both the business and public relations strategies. + Develops corporate communications to be shared with senior leadership. + Supports trend management by conducting analysis of drug spend, utilization, and/or approval scenarios. + 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. + Works under minimal supervision, using independent judgment requiring analysis of variable factors and determining the best course of action. + Facilitates and consults across teams and managing projects working collaboratively and communicating with staff in different positions and all levels of management positions + Manages the Humana Michigan FIDE-SNP health plan relationship with our internal PBM, Humana Pharmacy Solutions ensuring compliance with programmatic requirements, such as claims processing, prior authorization, formulary management and clinical programming + Represents Humana at all Pharmacy Medicaid meetings including those with the Michigan Department of Health and Human Services (MDHHS) **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree in Pharmacy or Doctor of Pharmacy (PharmD) + Must have an active Pharmacist license with the Board of Pharmacy in the appropriate state AND have a Michigan license or ability to obtain + Minimum of ten plus years of Pharmacy Experience with at least three years' experience in managed care and/or PBM operations + Ability to travel 10% of time + Successful track record in facilitating and consulting across teams and managing projects + Thrives in a fast paced, multi-project work environment while still ensuring attention to detail + Excellent communication skills, both oral and written + Proficiency in Microsoft Word, Excel, & PowerPoint + Expertise in working collaboratively and communicating with staff in different positions and all levels of management position **This position is open to candidates nationwide; however, you must have a current Michigan license and/or willing to obtain within 6 months of hire. Preference to candidates who currently live in or in the vicinity of Michigan.** **Preferred Qualifications** + Bachelor's degree (or higher) in public health, Business Administration or a related field + Board Certified Specialty Pharmacist + Experience with Microsoft Access & Microsoft Project + Experience with data analytics **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. $126,300 - $173,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-25-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$44k-63k yearly est. Easy Apply 7d ago
Sr. Cloud Architect - NoSQL Database Engineer
Humana 4.8
Boise, ID jobs
**Become a part of our caring community and help us put health first** The NoSQL Database Engineer will design, implement, and support MongoDB, Neo4j, and vector database solutions within Humana's enterprise architecture. The role requires hands-on experience with cloud platforms (Azure and/or GCP) and strong development skills using Python. The engineer will ensure secure, scalable, and high-performing database environments, collaborating with cross-functional teams to advance business goals and support modern technology initiatives. **Job Description Summary:** Humana is seeking a seasoned NoSQL Database Engineer to join the Data Platform Engineering team. The successful candidate will design, implement, and support MongoDB Atlas and MongoDB Enterprise, Neo4j, and Vector enabled database solutions within Humana's enterprise architecture. This role requires at least 10 years of experience, hands-on expertise with cloud platforms (Azure and/or GCP), strong Python development skills, and significant experience with Kubernetes for container orchestration. The engineer will ensure secure, scalable, and high-performing database environments, collaborating with cross-functional teams to advance business objectives and support modern technology initiatives. **What you'll do:** Design, implement, and optimize NoSQL database solutions using MongoDB Atlas, MongoDB Enterprise, Neo4j and AI features. Develop and maintain infrastructure automation using Terraform, integrating with Azure and/or GCP. Deploy, manage, and scale database workloads using Kubernetes to ensure reliability and operational efficiency. Ensure robust database security, backup, recovery, and regulatory compliance in alignment with Humana's standards. Monitor database performance, troubleshoot issues, and provide L3 support for production environments. Collaborate with stakeholders and cross-functional teams to integrate database solutions within the enterprise architecture. Develop Python-based automation and data workflows. Document processes and solutions in accordance with established SDLC and cloud engineering standards. **We're looking for someone who:** Minimum of 10 years of experience in Database engineering experience working with MongoDB Atlas / Enterprise and Neo4j (equivalent). Hands-on experience with Azure and/or GCP cloud platforms (Azure and/or GCP). Strong proficiency in Python (preferred) for automating database tasks. Demonstrable expertise with Kubernetes for managing containerized database workloads. Hands-on experience with GitOps workflows and tools. Experience utilizing AI development tools within engineering and data environments. Experience with infrastructure-as-code tools, especially Terraform. Familiarity with cloud security, access management, and regulatory compliance best practices. Excellent communication and documentation skills. Is eager to solve tough problems. Has excellent communication skills. Is curious, collaborative, and motivated. **Success Measures** **3 Month Goals:** + Successfully onboard to the Data Platform Engineering team and develop strong working relationships with cross-functional stakeholders. + Review Humana's enterprise architecture, DevOps governance, and cloud security standards (reference (********************************************************************************************************* ). + Assess current MongoDB Atlas, MongoDB Enterprise, Neo4j, and vector database environments; document initial findings and opportunities. + Demonstrate proficiency with Kubernetes orchestration and GitOps workflows through setup or enhancement of development environments. + Begin contributing Python automation scripts and infrastructure-as-code solutions using Terraform for cloud platforms (Azure and/or GCP). **6 Month Goals:** + Lead the implementation or optimization of secure, scalable NoSQL solutions, with measurable improvements in performance and reliability. + Integrate AI development tools into data workflows to support analytics and innovation. + Deliver at least one successful production deployment using Kubernetes and GitOps principles. + Establish and document best practices for database security, backup, and compliance. + Collaborate with DevOps and cloud teams to refine CI/CD pipelines and ensure alignment with Humana's standards. + Track key performance indicators (KPIs) such as deployment frequency, reliability, and code quality metrics. **12 Month Goals:** + Deliver fully operational, compliant, and high-performing NoSQL database environments supporting critical business applications. + Provide thought leadership in data platform modernization, leveraging AI, automation, and cloud-native technologies. + Achieve demonstrable improvements in uptime, incident response, and regulatory compliance across managed database environments. + Mentor junior engineers and contribute to knowledge sharing within the Data Platform Engineering team. + Document and present lessons learned, successes, and future recommendations to leadership. + Ensure continued alignment with Humana's enterprise cloud and security engineering standards. **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree in Computer Science, Engineering, Information Technology, or related field. or 10 years of hands on NoSQL Cloud Architecture experience. + Proven experience with MongoDB and Neo4j in an enterprise environment. + Practical knowledge of vector databases and modern data technologies. + Strong experience with cloud platforms (Azure and/or GCP), including cloud-native application deployment. + Proficiency in Python development for automation and database management. + Hands-on experience with Kubernetes, including AKS (Azure Kubernetes Service) or GKE (Google Kubernetes Engine) for deployment, scaling, and management of containerized applications. + Solid understanding of database and cluster security, automation, and DevOps practices. + Excellent problem-solving and communication skills. **Preferred Qualifications** + Certifications in NoSQL database technologies or cloud platforms. + Good knowledge of Kubernetes + Experience in healthcare, insurance, or other regulated industries. + Familiarity with data governance frameworks and compliance standards. **Additional Information** **Work-At-Home Requirements** + WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. + A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. + Satellite and Wireless Internet service is NOT allowed for this role. + A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information \#LI-Remote Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $129,300 - $177,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-14-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$129.3k-177.8k yearly 23d ago

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Updated December 11, 2025

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