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Mount Carmel Health System Remote jobs

- 77 jobs
  • Director Enterprise Data Quality and Stewardship

    Humana 4.8company rating

    Columbus, OH jobs

    **Become a part of our caring community and help us put health first** Director Enterprise Data Quality and Stewardship The Data Governance Director will be the senior leader responsible for working with the Enterprise Data Governance & Protection Office, coordinating with Enterprise Business Segments, Enterprise Data and Analytics Leaders and IT Leaders to ensure high levels of data quality, integrity, privacy, availability, security and usability and adherence to corporate policies, enterprise standards and procedures. This role will work to move the enterprise forward in the adoption and application of data governance standards and best practices. Collaboration will be at the core of success as this role will work with cross-functional teams spread across business segments and IT. Successful candidates will be self-motivated, collaborative, proactive, and possess high emotional intelligence sensitive to the varying and competing needs and dynamics of different stakeholders. Some key responsibilities of the Director Enterprise Data Quality and Stewardship include (& not limited to): + Drive Data Governance activities across Business Segments and responsible for driving accountability, policy compliance and data quality issue resolution through collaboration across key stakeholders. Work with Business Owners to ensure assignment of Data Stewards, identify critical data assets and produce plans for the governance of critical data assets and information. + Accountable for day-to-day Data Governance Operations oversight: Drive enterprise data-decision making processes and facilitate discussion to address conflicting viewpoints with the goal of arriving at mutually satisfactory agreements. + Understand the enterprise's strategic direction, processes, rules, requirements and deficiencies. Guide enterprise stewardship needs for training, information sourcing; provisioning; consumption; standardization; and reporting & analytics. + Enable consistent use of data governance standards and capabilities across all business segments. Ensure data adheres to all business and enterprise standards and frameworks. + Develop & drive data quality management as a core component, ensuring that it is an integrated part of the overall data strategy. Establish clear, enterprise-wide standards for what constitutes "high-quality" data, covering dimensions like accuracy, completeness, consistency, timeliness, and uniqueness + Drive the resolution of data, information and processing challenges that are having an adverse impact on the operational environment and/or business performance. Identify opportunities for improvement and incorporate it in the data strategy. Conduct as-needed alignment meetings on strategic data-driven initiatives. + Exercise discretion and judgment regarding matters of significance, collaborating with Data Governance Leaders, Data Governance Council members, and other leader stakeholders to understand new capabilities, service offerings, standards and framework changes. + Lead cross-functional committee and Enterprise Data Governance Leadership council to orchestrate and communicate data governance efforts to support business goals and strategic priorities. + Socialize the value of the Data Governance program including benefits for stakeholders; rules for engagement; and the enforcement of data standards with operational procedures and governed solutions. + Provide coaching and development opportunities to the team and is responsible for completing and delivering bi-annual and annual performance reviews. + Demonstrated ability to be a change agent, embracing change and bringing others along. + Able to work within a fast-paced environment with quickly changing priorities. + Ability to work with multiple personality types and bring together groups with competing priorities and drive consensus. + Understanding of operations, technology, communications and process improvement/management. + Demonstrated ability and comfort with presenting and facilitating meetings with all levels of associates. **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree or equivalent experience + Strong understanding of enterprise data governance, data quality, data management concepts, principles and practices. + Ability to understand data models, data taxonomy, and a deep appreciation of data standards and data quality. + Strong leadership and organizational awareness with ability to facilitate and resolve conflicts. + Passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + Masters a plus. + 15+ years of Healthcare, Business, Financial Services, is required. + Prior data governance and/or data quality focused technology experience a plus + Data Steward Certification + SQL, Python, Power BI Remote/WAH 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 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $156,600 - $215,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 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 ***************************************************************************
    $156.6k-215.4k yearly 2d ago
  • Claims Review Representative

    Humana 4.8company rating

    Columbus, OH jobs

    **Become a part of our caring community and help us put health first** The Claims Review Representative makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Claims Review Representative performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills. **Where you Come In** The Claims Review Representative partners with professional staff on pre-screening review by applying guidance, and making an appropriate decision which may include interpretation of provider information or data. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge. **What Humana Offers** We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education. **Use your skills to make an impact** **Required Qualifications - What it takes to Succeed** + High School Diploma or equivalent. + Minimum of two years' proven experience in processing and adjudicating medical claims, with a track record of accurate and timely claim review completion. + Proven ability to maintain confidentiality and handle sensitive information in compliance with organizational policies and applicable regulations. + Solid understanding of medical coding terminology, including CPT, ICD-9, and ICD-10 codes. + Proficient in Microsoft Office applications, specifically Word, Excel, and Outlook, to effectively manage documentation and communications. + Exceptional attention to detail and accuracy in reviewing and processing claims. + Ability to quickly adapt to and learn new systems and technologies relevant to claims processing. + Strong organizational skills with the capacity to manage and prioritize multiple tasks based on business needs. + Bilingual fluency in English and Spanish **Preferred Qualifications** + Associate or bachelor's Degree. + Previous experience with CAS claims systems. + Foundational knowledge of finance principles related to claims processing. **Additional Information - How we Value You** + Benefits starting day 1 of employment + Competitive 401k match + Generous Paid Time Off accrual + Tuition Reimbursement + Parent Leave **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. **Interview Format** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. 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. $44,900 - $60,200 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: 12-18-2025 **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 ***************************************************************************
    $44.9k-60.2k yearly 2d ago
  • Referrals Coordinator

    Humana 4.8company rating

    Columbus, OH jobs

    **Become a part of our caring community and help us put health first** The Referrals Coordinator 2 process referrals from Military Treatment Facilities (MTFs) and civilian providers. The Referrals Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. The **Referrals Coordinator 2** handles some inbound calls, performs data entry into the medical management system, assigning an appropriate provider, reviewing for benefits, and/or medical necessity as required or pending to a nurse or supervisor who can complete or request additional information. **Role Responsibilities** + Recognizes a sensitive diagnosis and/or referral requiring Case Management and pend to appropriate point of contact for review. + Understands TRICARE benefits/limitations and Humana Military referral processes, MOUs with MTFs, and referral and UM policies. + Answers questions or contacts MTFs and/or civilian providers to obtain additional information that may be required to complete referral etc. + Requires assigning appropriate ICD10 code to referral as well as appropriate CPT Code. + Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. + Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. + Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion. **Use your skills to make an impact** **Required Qualifications** + **Our Department of Defense Contract requires U.S. citizenship for this position** + **Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services)** + 2 plus years of customer service experience **AND/OR** administrative/data entry experience + 2 plus years of healthcare experience with Intermediate working knowledge using medical terminology, CPT and ICD codes + Strong telephonic customer service skills to include active listening, interpersonal and rapport building, patient and empathetic attitude and trouble shooting skills + Must be able to work autonomously and be self-driven + Must meet be able to meet productivity metrics + Expertise with MS Office products (Outlook, Word, PowerPoint, Excel) and ability to easily navigate multiple computer applications + The ability and willingness to work an 8-hour shift between the hours of 8 a.m. to 5 p.m. Eastern Standard Time (EST) and some potential overtime (Based on business need) **Preferred Qualifications** + Veteran or Military Spouse + Individuals with an understanding of TRICARE benefits/limitations, Humana Military referral processes, MOUs with MTFs, and referral and UM policies. + College degree + Experience in a Managed Care setting + Advanced experience with medical terminology and ICD10 codes **Additional Information** **Training** : + Performed virtually, with length of training depending on progression of trainee - 1 - 2 months **Work at Home/Remote 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. $39,000 - $49,400 per year **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. **About us** 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 ***************************************************************************
    $39k-49.4k yearly 3d ago
  • Special Needs Plan- Support Social Services

    Humana 4.8company rating

    Columbus, OH 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 ***************************************************************************
    $25k-29k yearly est. Easy Apply 39d ago
  • Medicaid Provider Hospital Reimbursement Methodologies Analyst

    Humana 4.8company rating

    Columbus, OH 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 55d ago
  • Actuary, Medicaid Trend Analytics and Data Management

    Humana 4.8company rating

    Columbus, OH jobs

    **Become a part of our caring community and help us put health first** Own and manage Medicaid claims analytics dataset using Databricks. Ensure data accuracy, completeness, and readiness to support modeling, reporting, and decision-making. Requires strong project management skills to evaluate the downstream impacts of data changes on actuarial models, reporting tools, and financial results. Lead and manage data-related projects from scoping through post-production validation, partnering with teammates to implement data transformations, automation, and enhancements. Conduct in-depth analysis of healthcare claims to identify data issues and optimization opportunities. Work with actuarial, financial, and clinical teams to assess and determine optimal data solutions. Provide strategic recommendations on data architecture and improvements. Support team in identification of cost drivers, utilization patterns, and anomalies in Medicaid medical claims data. The Actuary, Analytics/Forecasting ensures data integrity by developing and executing necessary processes and controls around the flow of data. This role collaborates with stakeholders to understand business needs/issues, troubleshoots problems, conducts root cause analysis, and develops cost effective resolutions for data anomalies. Typical responsibilities, but not limited to: + Advises executives to develop functional strategies (often segment specific) on matters of significance. + Analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. + Establishes metrics, provides data analyses, and works directly to support business intelligence. + Evaluates industry, economic, financial, and market trends to forecast the organization's short, medium and long-term financial and competitive position. + Exercises independent judgment and decision making regarding job duties and related tasks and works under minimal supervision. + Uses independent judgment requiring analysis of variable factors and determining the best course of action. **Use your skills to make an impact** **Required Qualifications** + Bachelor's Degree + FSA or ASA plus relevant advanced degree, recent and relevant work experience, and/or other relevant professional designations. + MAAA + Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending) + Demonstrated project management skills with the ability to drive work independently and effectively lead through collaboration + Experience in managing large healthcare claim datasets and conducting trend analysis + Advanced knowledge of Databricks, SQL, or Python **Preferred Qualifications** + Ability to translate complex data into actionable insights + Effective communication skills for technical and non-technical audiences + Skilled in gathering customer input and translating it into clear business requirements that align with customer needs and objectives + Deep understanding of healthcare claims taxonomy (service categories, such as LTSS) **Additional information** **HireVue Statement** 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. **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. **Work at home 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. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $129,300 - $177,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 12-30-2025 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
    $54k-74k yearly est. Easy Apply 24d ago
  • Senior Product Designer

    Humana 4.8company rating

    Columbus, OH jobs

    **Become a part of our caring community and help us put health first** Our brokerage business is transforming how Medicare Advantage is sold, and design is at the heart of that change. As a Senior Product Designer, you'll join a growing digital organization that's pushing boundaries with next-gen technology, mobile-first experiences, and new ways of working to make complex decisions simple and human. You'll craft intuitive, accessible interfaces that empower users, partnering closely with product and engineering to bring ideas to life. In a highly regulated environment, you'll balance creativity with compliance, ensuring every interaction feels seamless and trustworthy. This is an opportunity to step into a senior role, work in an agile, fast-moving setting, and shape the future of digital healthcare through design. If you're passionate about mobile-first UX, honing your craft in Figma, and building products people love, we'd love to talk. **What You'll Do** + Design best-in-class mobile-first experiences that simplify how Medicare Advantage shoppers navigate their options + Translate insights into intuitive, accessible designs that meet user needs and business goals + Create low and high-fidelity prototypes in Figma leveraging design systems, best-in industry patterns, and micro interactions that enhance usability + Collaborate closely with Engineers, Design Researchers, and Content Designers to ensure cohesive, user-centered experiences + Make evidence-based design decisions using insights from research and data analytics + Apply and uphold mobile design standards, patterns, and principles for consistency and quality across the ecosystem + Balance ideal UX with technical feasibility and regulatory requirements, knowing when to push and when to pivot + Lead early concepts, wireframes, and prototypes to bring ideas to life and guide development + Contribute to and evolve our design system with scalable, mobile-first components **Use your skills to make an impact** **What We're Looking For** + 5+ years of experience in product or UX design demonstrated through a strong mobile-first portfolio + Advanced Figma skills, including component libraries and prototyping + Proven ability to work in agile teams and partner effectively with developers, researchers, and content designers + Ability to leverage research and analytics to inform and validate design decisions + Strong communication skills to articulate design decisions and build consensus + Familiarity with accessibility standards and inclusive design principles + Strong organizational skills and ability to manage multiple priorities in a fast-paced, dynamic environment **Nice to Have** + Background in healthcare or other regulated industries + Experience with usability testing tools and analytics + Experience in Illustration for digital products + Contributions to design systems or pattern libraries **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. $86,300 - $118,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-02-2026 **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 ***************************************************************************
    $86.3k-118.7k yearly 2d ago
  • Senior Learning Design Professional

    Humana 4.8company rating

    Columbus, OH jobs

    **Become a part of our caring community and help us put health first** The Senior Learning Design Professional uses instructional design, cognitive psychology and adult learning theory to determine the appropriate solution to a knowledge or performance gap, followed by design, development, and delivery. The Senior Learning Design Professional work assignments involve moderately complex to complex topics and will require proficient project management skills and time management. This role will be focused on development of learning experiences specifically for the Care Management line of business including both clinical and non-clinical roles. **The Senior Learning Design Professional will support Clinical Care Management.** Analyzes and organizes content, designs solutions, and develops storyboards, scripts, performance support materials, mobile learning, and manuals. Assesses 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. **Additional responsibilities include:** + 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 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. 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 or 5 or more years of working instructional design experience including creation of CBT's, PowerPoint, Facilitator Guides, Job-Aids, Self-Paced Learning. + Prior experience working in a fast-paced consumer centric company in a learning function. + Experience utilizing Articulate 360, Camtasia, and PowerPoint + Progressive business experience with a focus on learning strategies and adult learning theories + Must be passionate about contributing to an organization focused on continuously improving consumer experiences + Must be able to work efficiently, multi-task, and pivot as project priorities change. + 2 years or greater of experience with Project Management **Preferred Qualifications** + Master's Degree in one of the following areas: Learning and Performance; Education; Instructional Design; Organizational Design or related field. + Work experience in a health care and / or Insurance setting + Clinical and/or Care Management work experience. + Experience working in CSOD uploading curricula and creating Events & Sessions. **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 **Interview Format:** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-29-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
    $71.1k-97.8k yearly 5d ago
  • Bilingual (English/Tagalog) Broker Agent Service Specialist - Hybrid in Multiple Locations

    Unitedhealth Group 4.6company rating

    Dublin, OH jobs

    **$1,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS** At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts on the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together.** Positions in this function provide support for our year-round Language Strategy by supporting consumers with specific Language needs through end-to-end call handling or acting as an interpreter based on license status. The Team also supports our Group Retiree Consumers in a Sales Support capacity to provide education to Retiree's who are offered custom plan benefits. This position is full - time (40 hours / week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (7:00am to 10:00pm CST). It may be necessary, given the business need, to work occasional/mandatory overtime that could include a Saturday. This is a Hybrid role - working a combination of onsite and at home. 3-4 days are required in office per week. **Work Locations:** + Phoenix, AZ: 430 North Scottsdale Road, Tempe, AZ 85288 + Minnetonka, MN: 9800 HEALTH CARE LANE, MINNETONKA, 55343 + Miami, FL: 1000 NW 57th Court, Miami, FL, 33126 + De Pere, WI: 2020 Innovation Court, De Pere, WI + Colorado Springs, CO: 9945 Federal Drive, Colorado Springs, CO + Englewood, CO: 169 Inverness Drive, Englewood, CO + Maryland Heights, MO: 13655 Riverport, Maryland Heights, MO + Roanoke, VA: 3645 Thirlane Road NW, Roanoke, VA + Dublin, OH: 5900 Parkwood Place, Dublin, OH If you are located within a commutable distance to any of the above locations, you will enjoy the flexibility of a hybrid-remote position* as you take on some tough challenges. **Primary Responsibilities:** + Primary support for consumers and members needing in-language support + Support inbound call volume with potential for occasional outbound for consumers and members + Provide education during Q3 and Q4 for Group Retiree inbound call volume + Uptrained to support Group Retiree prospective member chats through LivePerson technology. This includes completing enrollment applications through LivePerson as applicable. This is an uptraining after 1 year in the role and based on license status + Flexible and ability to adapt to special projects/campaigns to support year-round business needs. + Use knowledge of Medicare product portfolio to accurately assess the distinct needs of different prospects, explain the differences between various products and assist the prospective member in selecting a product that best meets their unique needs + Accurately and thoroughly complete and submit required documentation, consistent with Medicare requirements and guidelines + Meet and maintain requirements for agent licensure, appointments, and annual product certification You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + High School Diploma/GED (or higher) OR 6+ months of customer service/sales experience + Health insurance license in state of residence OR ability to obtain within 6 months of starting employment + Intermediate level of proficiency with computer and Windows PC applications, including the ability to learn new and complex computer systems and apply for phone and off-phone activity + Ability to read, write, and speak fluently in English and our target language: Tagalog + Flexibility to work assigned shift within the hours of operation (Monday - Friday 7am - 10pm CST) **Soft Skills:** + Ability to type and talk at the same time and navigate through multiple screens + Ability to follow outlined process and business expectations + Ability to multi-task in a fast-paced environment + Comfortable navigating between multiple computer systems running concurrently to search and share information with the consumer + Flexible to workflow changes and alter course when appropriate + Open to coaching and development + Ability to successfully field inbound and outbound calling campaigns + Consumer centric mindset **Telecommuting Requirements:** + Reside within Minnetonka, MN, Miami, FL, OR Phoenix, AZ + Required to have a dedicated work area established that is separated from other living areas and provides information privacy + Ability to keep all company sensitive documents secure (if applicable) + Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. ****PLEASE NOTE** The sign-on bonus is only available to external candidates. Candidates who are currently working for UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus.** Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._ \#RPO #YELLOW
    $20-35.7 hourly 3d ago
  • Business Intelligence Lead

    Humana 4.8company rating

    Columbus, OH jobs

    **Become a part of our caring community and help us put health first** The Business Intelligence Lead solves complex business problems and issues using data from internal and external sources to provide insight to decision-makers. The Business Intelligence Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Business Intelligence Lead describes the tools, technologies, applications and practices used to collect, integrate, analyze, and present an organization's raw data to create insightful and actionable business information. This individual advises executives to develop functional strategies (often segment specific) on matters of significance. The Business Intelligence Lead exercises independent judgment and decision making on complex issues regarding job duties and related tasks and works under minimal supervision. The Business Intelligence Lead uses independent judgment requiring analysis of variable factors and determining the best course of action. **Use your skills to make an impact** **Required Qualifications** + Undergraduate degree + Minimum 8 years of technical experience in data reporting and analytics utilizing Power BI or similar tool + Minimum 2 years of experience in leading business intelligence strategy and/or processes + Experience working with large and complex data sets within large organizations and/or the analysis of healthcare data + 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 + Excellent communication and presentation skills to include the ability to communicate and present technical/financial details to Senior/Executive level leadership and/or Senior Government officials **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** + Advanced Degree in a quantitative discipline, such as Mathematics, Economics, Finance, Statistics, Computer Science, Engineering or related field + Minimum 4 years of experience working in the LI NET program and 4 years' technical experience in data reporting and analytics + Experience or exposure to generative AI models for data analysis tools + Advanced experience in SQL, SAS, Azure Synapse Analytics (ASA), and/or Databricks + Expertise in data mining, forecasting, simulation, and/or predictive modeling + Experience creating analytics solutions for various healthcare sectors + Experience in Medicare/Medicaid, CMS (Centers for Medicare & Medicaid Services) or other Federally regulated healthcare programs + Demonstrated capability with coaching, mentoring and developing associates formally and informally + Ability to monitor and recommend improvements to increase team productivity by patiently providing expert advice and assistance to other associates on the team **Additional Information** + 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. 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. **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 5d ago
  • Field-Based Case Manager - Remote in Pickaway County in OH Market

    Unitedhealth Group 4.6company rating

    Circleville, OH jobs

    At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together** As a Field-Based Case Manager (CM), you will act in a liaison role to ensure appropriate care is accessed, as well as to provide home and social assessments and member education. Case Managers work in a team based structure and spend the majority of their time in the community engaging directly with members. **If you reside within a commutable distance of Pickaway, Fairfield, Ross, Fayette or Madison Counties, OH, you will have the flexibility to work remotely* as you take on some tough challenges.** **Primary Responsibilities:** + Engage members either face to face or over the phone to assist with closing gaps in care, linking to necessary services and providing education about their health + Review available member service records and relevant documentation (e.g. utilization history, functional level, stratification information, current plan of care) + Conduct member health assessment that includes bio-psychosocial, functional, and behavioral health needs + Utilize interviewing techniques and active listening to collect and retain member information and incorporating responses as they are presented to complete assessment + Identify member service needs related to health concerns + Identify urgent member situations + Engage member to participation in the assessment process and collaboratively develop Care Plan based on individual needs, preferences, and objectives + Provide nursing oversight while collaborating with Care Guides (CGs) + Work with members to develop healthcare goals and identify potential barriers to achieving healthcare goals + Identify member support systems available and incorporate into their Care Plan + Review plan benefits and identify appropriate programs and services based on health needs and benefits + Integrate health care and services needs into a plan or recommendation for member care and service + Work collaboratively with the interdisciplinary care team to ensure an integrated tam approach + Collaborate with member to create solutions to overcome barriers to achieving healthcare goals + Identify relevant community resources available based on member needs + Refer members to appropriate programs and services + Facilitate member choice of preferred provider + Advocate for individuals and communities within the health and social service systems You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + State of Ohio RN License, and applicable degree + Field-based experience + Knowledge of culture and values of community + Familiarity with the resources available in the community + Resided within the local community for 2+ years + Reside or be able to commute within Jefferson County, Ohio + Ability to travel locally up to 75% of the time + Access to reliable transportation that will enable you to travel to member and/or patient sites within a designated area + Available to work Monday through Friday 8:00 AM to 5:00 PM + Have a dedicated work area established that is separated from other living areas and provides information privacy + Proven ability to keep all company sensitive documents secure + Live in a location that can receive UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service **Preferred Qualifications:** + Case Management Certification (CCM) + Care management experience + Experience working in Managed Care + Telephonic customer service experience + Knowledge of Medicaid and/or Medicare population + Knowledge and/or experience with behavioral health or substance use disorders + Employment in a medical office or other provider environment *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. \#UHCPJ _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
    $28.3-50.5 hourly 60d+ ago
  • Medical Director - Post-Acute Care Management - Care Transitions - Remote anywhere in US

    Unitedhealth Group 4.6company rating

    Cleveland, OH jobs

    Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** **Why Care Transitions?** At Care Transitions, our mission is to work with extraordinarily talented people who are committed to making a positive and powerful impact on society by transforming health care. Care Transitions is the result of almost two decades of dedicated visionary leaders and innovative organizations challenging the status quo for care transition solutions. We do health care differently and we are changing health care one patient at a time. Moreover, have a genuine passion and energy to grow within an aggressive and fun environment, using the latest technologies in alignment with the company's technical vision and strategy. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. We are currently looking for Medical Directors that can work daytime in any of the continental time zones in the US. **Primary Responsibilities:** + Provide daily utilization oversight and external communication with network physicians and hospitals + Daily UM reviews - authorizations and denial reviews + Conduct peer to peer conversations for the clinical case reviews, as needed + Conduct provider telephonic review and discussion and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care + Communicate effectively with network and non-network providers to ensure the successful administering of Care Transitions' services + Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers + Represent Care Transitions on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders + Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers + Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals + Interact, communicate, and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees + Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting + Regularly meet with Care Transitions' leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues + Provide input on local needs for Analytics Team and Client Services Team to better enhance Care Transitions' products and services + Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME + Participate on the Medical Advisory Board + Providing intermittent, scheduled weekend and evening coverage + Perform other duties and responsibilities as required, assigned, or requested You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Board certification as an MD, DO, MBBS with a current unrestricted license to practice and willing to maintain necessary credentials to retain the position + Current, unrestricted medical license and the ability to obtain licensure in multiple states + 3+ years of post-residency patient care, preferably in inpatient or post-acute setting **Preferred Qualifications:** + Licensure in multiple states + Willing to obtain additional state licenses, with Optum's support + Understanding of population-based medicine, preferably with knowledge of CMS criteria for post-acute care + Demonstrated ability to work within a team environment while completing multiple tasks simultaneously + Demonstrated ability to complete assignments with reasonable oversight, direction, and supervision + Demonstrated ability to positively interact with other clinicians, management, and all levels of medical and non-medical professionals + Demonstrated competence in use of electronic health records as well as associated technology and applications + Proven excellent organizational, analytical, verbal and written communication skills + Proven solid interpersonal skills with ability to communicate and build positive relationships with colleagues + Proven highest level of ethics and integrity + Proven highly motivated, flexible and adaptable to working in a fast-paced, dynamic environment *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Compensation for this specialty generally ranges from $238,000 to $357,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
    $238k-357.5k yearly 20d ago
  • RN Clinical Care Coordinator - Franklin County, OH

    Unitedhealth Group 4.6company rating

    Columbus, OH jobs

    At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start **Caring. Connecting. Growing together** The RN Clinical Care Coordinator will be the primary care manager for a panel of members with complex medical/behavioral needs. Care coordination activities will focus on supporting members' medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care. This is a home-office based position with field responsibilities. You will spend approximately 50% to 75% of the time in the field within an assigned coverage area. Candidates must be in Franklin County, OH and willing to commute to surrounding counties. If you reside in Franklin County, OH or surrounding counties, you will have the flexibility to work remotely* as you take on some tough challenges. **Primary Responsibilities:** + Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs + Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines + Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan + Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health + Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission + Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Current, unrestricted independent licensure as a Registered Nurse in Ohio + 2+ years of clinical experience as an RN + 1+ years of experience with MS Office, including Word, Excel, and Outlook + Reliable transportation and the ability to travel up to 75% within Franklin County, OH and surrounding counties in OH to meet with members and providers + Reside in Franklin County, OH and surrounding counties **Preferred Qualifications:** + BSN, Master's Degree or Higher in Clinical Field + CCM certification + 1+ years of community case management experience coordinating care for individuals with complex needs + Experience working in team-based care + Background in Managed Care *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. #UHCPJ _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
    $28.3-50.5 hourly 25d ago
  • Medical/Financial Risk Evaluation Professional 2

    Humana 4.8company rating

    Columbus, OH 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 6d ago
  • Senior Technology Implementation Professional-Blackline System Admin

    Humana 4.8company rating

    Columbus, OH jobs

    **Become a part of our caring community and help us put health first** Humana Finance Organization is seeking a Senior Technology Implementation Professional to provide system implementation and production support for vended solutions in Finance. In this role, you will collaborate with Finance business and IT partners to review requirements, document system issues, and implement systems functionalities or provided resolutions to resolve issues. The Senior Technology Implementation Professional delivers new technological solutions to meet business needs within a specified scope while aligned to enterprise objectives. The Senior Technology Implementation Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.The Senior Technology Implementation Professional gathers and documents business system and functional requirements, influences system design, often in collaboration with IT, to optimize support and ensures solutions meet the business objectives and requirements. Completes and/or coordinates implementation of design and requirements, testing, operational readiness, and provide system support for finance applications. Also, begins to influence department's strategy and makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. **Use your skills to make an impact** **Required Qualifications** - Bachelor's degree in Accounting, Finance, Management Information System or a related field. - 3+ years of Blackline system implementation experience or systems support. - Knowledge of business acumen regarding financial/system data flow, reconciliations and general knowledge of basic accounting - Experience with systems support and execution including artifacts development, collaboration with cross functional teams' effort and effective communication at various levels, including senior leaders. - Knowledge of Systems Development Life Cycle, Waterfall, and Agile Development Methodologies and system testing. - Experience in problem solving, consultation within complex environments and managing multi priorities relating to project/assignments. - Proficient with Microsoft Suite of products including Excel, Word, Outlook, Power Point and Projects. Preferred Qualifications - Master's Degree of Business Administration, Computer Science or a related field - Experience in Oracle EBS or Oracle Cloud Fusion ERP - Skilled in detail design and process documentation - Experience in analysis, design, data modeling in Microsoft SQL Server, development of Access databases/applications and general data management **Additional Information** SSN Alert 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. Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. WAH Internet Statement To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $80,900 - $110,300 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. 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 ***************************************************************************
    $80.9k-110.3k yearly Easy Apply 41d ago
  • Community and State Community Initiatives Director - Ohio Market - Remote

    Unitedhealth Group Inc. 4.6company rating

    Dublin, OH jobs

    At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together UnitedHealth Group is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? If you are located in the state of OH, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: * In close coordination with the Population Health Director, oversee the plan's strategic design, implementation, and evaluation of population-specific improvement efforts in the context of the MCO's population health initiatives * Oversee the plan's strategic design, implementation, and evaluation of community engagement and investment efforts in the context of the plan's population health initiatives in close coordination with the Population Health Director * Lead and manage a team responsible for advancing community health initiatives, including oversight of staff supporting health related social needs workgroups and health outcomes related measurement execution for accreditation * Serve as the lead for the Sponsorship Committee, overseeing strategy, evaluation, and alignment of sponsorships with community engagement priorities, population health goals, and the organization's business growth objectives. Ensure sponsorship efforts are integrated with broader community engagement strategies and investments to maximize impact and sustainability * Inform decision-making around best payer practices to ensure optimal outcomes for all populations through provision of applicable and relevant population-specific and community-based research and resources, as well as ensuring member perspectives from all subpopulations are incorporated into the codesign of policy and service provision, including the tailoring of population-specific intervention strategies, and ensuring alignment with NCQA Health Outcomes Accreditation &/or Community-Focused Care accreditation standards and reporting requirements * Collaborate with the MCO's Chief Information Officer to ensure the MCO collects and meaningfully uses race, ethnicity, and language data to identify opportunities for improvement * Provide strategic guidance and facilitation to internal workgroups focused on addressing health related social needs, ensuring initiatives are data-informed, and aligned with ODM & NCQA expectations * Coordinate and collaborate with members, providers, local and state government, community-based organizations, ODM, and other ODM-contracted managed care entities to impact differences in health outcomes at a population level * Ensure that efforts to address poor health outcomes are codesigned with the targeted sub-populations and their providers, developed collaboratively with other ODM-contracted managed care entities to have a collective impact, and integrated with community engagement strategies and investments. Lessons learned are incorporated into future decision-making * Designs, implements, and evaluates programs to reduce health disparities. Uses data to drive decision-making and measurement of progress * Coordinate and collaborate with members, providers, local and state government, community-based organizations, the Ohio Department of Medicaid (ODM), and other ODM-contracted managed care entities to impact population health at the population level * Ensure that efforts addressed at improving population health are designed collaboratively with other ODM contracted managed care entities to have a collective impact for the population and that lessons learned are incorporated into future decision-making * Provides visionary leadership and contributes to the successful advancement of culture, population health and social responsibility principles. Responsible for being a champion of culture, cultivating innovation, and inspiring others * Builds and deploys strategies and initiatives that identify structural impediments to disparate populations * Demonstrates organizational agility and understands how the business operates and can identify and interpret business levers. Creates experiences that shape and grow the organizations' culture programs and capabilities You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Bachelors Degree * 5+ years of professional work experience, preferably in public health, social/human services, social work, public policy, health care, education, community development, or justice related fields * 5+ years of experience interfacing with Senior Leadership team * Have experience in actively applying or overseeing the application of science-based quality improvement methods to reduce differences in health outcomes * Demonstrated community and stakeholder engagement experience * Experience addressing health disparity concerns * Experience and knowledge of change management principles, methodologies and tools * Experience working with and leading cross-functional teams and projects * Experience utilizing excellent time management, organizational, and prioritization skills and ability to balance multiple priorities * Experience utilizing solid problem solving and analytical and skills * Experience utilizing excellent communication skills both written and verbal * Intermediate to advanced level of proficiency with Microsoft Word, Microsoft Project, Microsoft Excel, Visio, Microsoft PowerPoint and SharePoint * Expert level of proficiency in Microsoft PowerPoint and Microsoft TEAMS * Proven self-directed, independent and track record of problem solving, initiation and leadership for extremely complex, visible and multifaceted topics * Demonstrated ability leading across organizational silos when presented with highly complex and undefined work * Reside in Ohio * Ability to travel up to 25% of the time, throughout the state of Ohio and limited nationwide travel Preferred Qualifications: * Experience working with Medicaid and/or Medicare programs * Experience working in a matrix environment and influencing all levels of employees; inspiring others to engage, participate and act * Proven excellent communication skills - including verbal, written, interpersonal, presentation, and facilitation skills - with a proven ability to manage conflict, resolve issues, mitigate risks and influence leaders * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $110,200 to $188,800 annually based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
    $110.2k-188.8k yearly 21d ago
  • Senior Specialty Consultative Pharmacist

    Humana 4.8company rating

    Homeworth, OH jobs

    Become a part of our caring community and help us put health first As a member of the Specialty Clinical Team, you can work a variety of tasks based upon business need. Daily work assignments include both inbound and outbound calls to patients to discuss medication therapy, side effect management and adverse event reporting when appropriate. New Hire Bonus: Earn a $5,000 Bonus! Payment is made after completing 180days of employment. You must be employed until that date to be eligible to receive the payment. The Senior Specialty Consultative Pharmacist primary responsibility will be to assess and evaluate the conditions of our members, with a particular emphasis on medication therapy, through telephonic interactions to ensure they achieve and maintain optimal wellness. Additionally, you will develop and implement comprehensive care plans, monitor patient progress through regular assessments, and utilize advanced telecommunication systems to provide medication education. The ideal candidate will demonstrate strong clinical expertise, exceptional communication skills, and the ability to work independently while adhering to established protocols and guidelines. This position offers the opportunity to make a significant impact on the lives of patients with serious and rare health conditions within a supportive and professional environment. As a member of the Specialty Clinical Team, you can work a variety of tasks based upon business need. Daily work assignments include both inbound and outbound calls to patients to discuss medication therapy, side effect management and adverse event reporting when appropriate. Additional tasks that are not directly phone call related include but are not limited to: Review prescriptions for accuracy Check for drug-drug interactions Evaluate appropriateness of disease state, dosage, directions and therapy Utilize electronic resources and guidelines to assist in professional decision making Use your skills to make an impact Required Qualifications Pharmacy degree from an accredited college of pharmacy (PharmD) Active Pharmacist license from the state of Florida, Texas, Ohio or Arizona Board of Pharmacy Minimum three, (3) years of experience as a pharmacist in a high-volume retail, hospital or mail order pharmacy practice environment Ability to participate in Federal prescription programs Ability to work independently and within a team setting to achieve goals and meet deadlines Proven problem-solving skills and strong ability to utilize resources for professional decision-making Work ethic that is focused, accurate and highly productive Excellent verbal and written skills with ability to communicate effectively within the team and to patients or caregivers Comprehensive knowledge of Microsoft Office applications, including Word, Excel, Outlook and OneNote Knowledge navigating multiple systems/platforms and ability to troubleshoot and resolve general technical difficulties in a remote environment. Preferred Qualifications Pharmacist Board Certification - Oncology, Specialty, Geriatric, Pharmacotherapy, Ambulatory Proficient in Spanish - If applicable, please specify this on application/resume when applying Previous experience in a Specialty Pharmacy setting Previous experience with Pharmacy Benefits Management (PBM) Previous Commercial, Medicare and/or Medicaid experience Previous clinical experience in managed care Additional Information New Hire Bonus: Earn a $5,000 Bonus! Payment is made after completing 180days of employment. You must be employed until that date to be eligible to receive the payment. Workstyle: Remote Location: Must reside in Ohio, Florida, Texas or Arizona only Training Schedule: 40-hour work week Eastern Time 4-week training Monday through Friday 8:00 am - 5:30 pm Eastern Department Schedule: Typically, 40-hour work week Eastern Time - Leaders will discuss during the interview Business Hours: Monday-Friday, 8:00 a.m.-8:00 p.m.; Saturday, 8:00 a.m.-6:30 p.m. Typical Shift: Monday-Friday, 10:00 a.m.-6:30 p.m. Includes two late shifts per week 11:30 a.m.-8:00 p.m., with rotating Friday closing and occasional Saturday coverage. Holiday rotation and mandatory overtime may be required to meet business needs. Work-At-Home Requirements 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. 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. Language Assessment 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. SSN Alert Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $104,000 - $143,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us About CenterWell Pharmacy: CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.About CenterWell, a Humana company: CenterWell creates experiences that put patients at the center. As the nation's largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first - for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
    $37k-59k yearly est. Auto-Apply 7d ago
  • Senior Technical Finance Analyst- Medicaid

    Humana 4.8company rating

    Columbus, OH jobs

    **Become a part of our caring community and help us put health first** The Senior Market Finance Professional supports more than half of Humana's Medicaid business, providing technical financial analysis and data-driven insights to drive market growth and operational effectiveness. This position resides within the Finance team and partners directly with Market CFOs, clinical teams, and provider engagement teams, focusing on Medicaid claims and premium analytics across multiple states, including established and expansion markets. Key Responsibilities: + Collect, analyze, and report on market data connecting financial outcomes with operational results, particularly in Medicaid claims and premiums. + Deliver project-based and ad-hoc reporting for Medicaid markets; provide insights into membership analysis, provider performance, RFPs, and market trends. + Manage ad hoc requests from Market CFOs, Presidents, and leadership, ranging from member utilization to premium reconciliation and strategic market analysis. + Design, code, and execute advanced SQL queries; independently pull and manipulate claims data from established databases. + Develop and present Power BI dashboards and visualizations (preferred); alternatively, collaborate with internal teams for BI support. + Lead data presentations for provider Joint Operating Committee (JOC), focusing on performance drivers and improvement strategies in value-based risk arrangements. + Collaborate cross-functionally with market leadership, accounting, actuarial, clinical, operations, and Medicare counterpart teams. + Work closely with market actuaries; assist on actuarial exercises and daily coordination with actuarial teams. + Foster strong working relationships with stakeholders and providers, supporting direct business optimization efforts. + Adapt to a fast-paced, dynamic environment with continuous change and minimal structure. + Seek opportunities for career progression, including future advancement towards Market CFO **Use your skills to make an impact** Required Qualifications: + Bachelor's degree in finance, accounting, or related field. + 5+ years of experience in finance or a combination of finance and accounting. + Advanced SQL skills; capable of writing complex queries and data manipulation independently. + Proficiency with Excel and Power BI (or similar visualization tools). + Demonstrated experience presenting technical insights visually to management and stakeholders. + Strong attention to detail and ability to work independently. + Excellent cross-functional collaboration and relationship-building skills. + Passion for driving continuous improvement in consumer and provider experiences. Preferred Qualifications: + Experience with healthcare insurance, Medicaid, or claims data analytics + Prior exposure to financial analysis or interest in transitioning to actuarial or advanced finance roles. **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. **Why Humana?** **You'll experience the following perks as a full-time Humana employee:** 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 **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. **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. \#LI-Remote **Social Security Task** 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 4d ago
  • Per Diem Senior Corporate Director of Pharmacy - Remote

    Unitedhealth Group Inc. 4.6company rating

    Dublin, OH jobs

    Explore opportunities with CPS, part of the Optum family of businesses. We're dedicated to crafting and delivering innovative hospital and pharmacy solutions for better patient outcomes across the entire continuum of care. With CPS, you'll work alongside our team of more than 2,500 pharmacy professionals, technology experts, and industry leaders to drive superior financial, clinical, and operational performance for health systems nationwide. Ready to help shape the future of pharmacy and hospital solutions? Join us and discover the meaning behind Caring. Connecting. Growing together. As a per diem Senior Corporate Director of Pharmacy with CPS Solutions, LLC Advance Team, you will be deployed as needed to client sites located across the U.S., traveling 100% of the time to work. At the client site you act as a temporary Director of Pharmacy or Consultant in new and existing accounts and are primarily responsible to plan, organize, control and supervise operation activities in a pharmacy practice setting according to facility policies, standards of practice of the profession, and state and federal laws in hospitals with 250-500 licensed beds. Additionally, but not limited to, you will have the opportunity to be an integral team member with implementation of new contracts; performing Pre-Joint Commission and Joint Commission visits on current accounts; helping staff current accounts; putting into practice operational pharmacy improvements and working on special projects. You will be responsible for all aspects of operations, including assisting in recruitment and hiring of personnel; evaluating that all legal, accreditation, and certification requirements are being met; ensuring provision of optimal services; and working with Regional Directors, Directors of Pharmacy, and other hospital personnel to enhance performance of the pharmacy. In addition, you will be expected to work independently and handle challenges appropriately, work cooperatively with other members of Comprehensive Pharmacy Services, hospital and pharmacy staff, handle multiple tasks and adapt to changes in workload and work schedule, set priorities, make critical decisions, and respond to client concerns, foster a team environment by providing orientation and training to Directors of Pharmacy and pharmacy staff, communicate effectively (verbal and written) and demonstrate excellent customer service skills. In this role, you will have a full support team available to you-from a Regional VP, Regional Clinical Director, and 340B Specialist to a Regulatory Specialist, Drug Information Specialist, and more. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * B.S. or PharmD from an ACPE-accredited School of Pharmacy * Obtain/maintain 12+ different state Pharmacy licenses in CPS recommended states * 5+ years of recent hospital pharmacy management experience plus 3+ years hospital Pharmacist experience * Experience working at a Pharmacy Director level at hospitals with 250-500 beds in size * Proficiency with using computer applications including word processing, spreadsheets and pharmacy information systems * Ability to pass company Motor Vehicle (MVR) background check * Ability to travel 100% of working hours, typically 5 days on 2 off with flexibility for a 10 days on 4 off schedule when needed * Ability to travel on a 24 hour notice Hospital Requirements: (may be required): * (PPD) TB Skin Test - Proof of negative TB skin test within the last 12 months * (MMR) Measles, Mumps and Rubella or A Blood Titer proving immunity * Varicella - (2) documented doses or A Blood Titer proving * Hep B3 Series (or declination) * (Flu) Influenza-required for hire between Oct 1st-April 30th * COVID Vaccine-Full (required) * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $52.98 to $90.77 per hour based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
    $53-90.8 hourly 60d+ ago
  • Physician Resident- Pathways| Unity Health Network

    Unitedhealth Group 4.6company rating

    Akron, OH jobs

    Physician Pathways: Prepare for **Day One** at your practice up to one year in advance of completing your resident of fellowship program. As a Pathways Physician, you'll receive a salary, mentoring, and various other learning experiences focused on preparing for your career with the Optum American Health Network with minimal impact on your Resident training time. Interested in learning more about Value Based Care before day one? Getting to know your peers? Ease the stress of your transition to physician provider with an unparalleled head start **"virtually"** **Optum American Health Network Primary Care Physicians -- Ohio Pathways** For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start **Caring. Connecting. Growing together.** As a part of the Optum network, American Health Network is seeking career-minded Family Medicine or Internal Medicine residents who want to jump start their clinical career. You'll enjoy the flexibility to work remotely *** from anywhere within the U.S.** as you take on some tough challenges. **Position Highlights:** + Receive a generous guaranteed salary in your final year of training + Enhance the experience of your final months of training and eliminate the burden of job searching; employment is guaranteed at the completion of your residency + Learn how to practice and thrive in a value-based care model + Gain exposure to the Quadruple Aim framework and various understandings of care settings + Receive mentorship from experienced physicians within your future practice, easing your transition from training into practice + The customized program will be completed at American Health Network facilities in Indiana, or Ohio, and virtually + The program requires a commitment of only a few hours per month **What makes Optum different?** + Providers are supported to practice at the peak for their license + As one of the most dynamic and progressive health care organizations in the country, Optum consistently delivers clinical outcomes that meet or exceed national standards + We promote a culture of clinical innovation and transformation + We are a top performer nationally of the Quadruple Aim initiative + We are influencing change on a national scale while still maintaining the culture and community or our local organizations You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Key Takeaways:** + Optum fosters a collaborative culture focused on growth, innovation and mutually uplifting one another, enabling deep physician satisfaction + Tailored development programs like Physician Pathways smooth the transition from training to practice with expert mentorship + Physicians praise the supportive environment facilitating work-life balance, strong patient connections, and the ability to push care delivery boundaries **Required Qualifications:** + M.D. or D.O. + Must be transitioning into your **final year** of residency or fellowship **Preferred Qualification:** + Preferred candidate will be a local physician resident in Ohio--open to other areas as well **Would you thrive with Optum?** + Do you strive to practice evidence-based medicine? + Are you seeking a practice focused on patient-centered quality care, not volume? + Are you a team player - comfortable delegating and empowering teams? + Are you constantly seeking better ways to do things? + Do you want to be part of something better? **About Optum:** At Optum, we've found that putting clinicians at the center of care is the best way to improve lives. Our physician-led organization is one of the most dynamic and progressive health care organizations in the world, serving almost 130 million people through more than 78,000 aligned physicians and advanced practice clinicians. You will find our team working in local clinics, surgery centers and urgent care centers, within care models focused on managing risk, higher quality outcomes and driving change through collaboration and innovation. Learn more at ************************************ *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. _Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._ _OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment_
    $49k-167k yearly est. 60d+ ago

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