Senior Learning Design Professional
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 ***************************************************************************
Senior Content Strategy
Columbus, OH jobs
**Become a part of our caring community and help us put health first** Humana is evolving its marketing organization to better acquire and engage members through data-driven, technology-enabled, and personalized communications and the creative and content produced by the in-house agency team known as the Hive, is a vital part of this transformation.
The **Senior Content** **Strategy** _(internally known as a Senior Professional, Creative Development)_ role will drive enterprise creative, marketing excellence, and enhance business value for Humana Inc. This position requires the experience and vision to inspire and develop marketing and creative strategies based on business objectives while building trusted relationships with our marketing partners.
**Key Role Functions**
+ Build strong, cross-functional partnerships with the internal agency team, marketing partners, and external agencies
+ Drive creative strategy in support of Customer Lifecycle Marketing (CLM)
+ Oversee customer-centric campaign strategies and conceptual milestones. Leverage performance marketing expertise to deliver breakthrough creative that drives results.
+ Lead by example. Demonstrate and enable collaboration, constructive critique, and agile workflows
+ Understand the business, industry and competition, leveraging that knowledge to help generate new ideas to strategically grow business and marketing strategy
+ Ensure work is on-strategy and appropriate for the brand and the business
+ Consistently collaborate with team members throughout the work process to foster, facilitate and consistently deliver great work that is on strategy, on time, and on budget
**Use your skills to make an impact**
**Required Qualifications**
+ Bachelor's degree
+ 5+ years of Marketing with a mastery of advertising fundamentals, including: branding, planning, positioning, strategy
+ 2+ years of advertising or internal agency experience
+ Ability to identify solutions that will generate measurable results
+ Independent self-starter and extremely detail-oriented
+ Able to present to Senior Leadership and influence decision makers
+ Ability to work well in a fast-paced team environment with an agile approach and iterative design process
**Preferred Qualifications**
+ Master's Degree
+ Performance marketing
**Additional Information**
**This role is a 100% remote role anywhere in the US and will primarily operate on Eastern Standard Time business hours.**
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
+ Satellite, cellular and microwave connection can be used only if approved by leadership
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
+ Health benefits effective day 1
+ Paid time off, holidays, volunteer time and jury duty pay
+ Recognition pay
+ 401(k) retirement savings plan with employer match
+ Tuition assistance
+ Scholarships for eligible dependents
+ Parental and caregiver leave
+ Employee charity matching program
+ Network Resource Groups (NRGs)
+ Career development opportunities
**Our Hiring Process**
As part of our hiring process for this opportunity, we may contact you via text message and email to gather more information using a software platform called HireVue. HireVue Text, Scheduling and Video technologies allow you to interact with us at the time and location most convenient for you.
If you are selected to move forward from your application prescreen, you may receive correspondence inviting you to participate in a pre-recorded Voice, Text Messaging and/or Video interview. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
If you have additional questions regarding this role posting and are an Internal Candidate, please send them to the Ask A Recruiter persona by visiting go/Buzz and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker.
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$78,400 - $107,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-10-2025
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
Easy ApplyAssociate Actuary, Analytics/Forecasting
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Associate Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Establishes metrics, provides data analyses, and works directly to support business intelligence. Evaluates industry, economic, financial, and market trends to forecast the organization's short, medium and long-term financial and competitive position. The Associate Actuary, Analytics/Forecasting work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
+ Join a newly established and rapidly growing team within Humana, where much of the work is built from the ground up to support our evolving goals.
+ Contribute to an area dedicated to delivering high-quality care to members in their home environments.
+ Engage in diverse responsibilities, including pricing contracts, forecasting savings, and handling various ad-hoc analytical projects.
The **Associate Actuary, Analytics/Forecasting** ensures data integrity by developing and executing necessary processes and controls around the flow of data. Collaborates with stakeholders to understand business needs/issues, troubleshoots problems, conducts root cause analysis, and develops cost effective resolutions for data anomalies. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
The position is in the Home organization at Humana. The role will be particularly focused on value-based care strategies and initiatives for the home health business at Humana. Some responsibilities involve but not limited to:
+ Standard reporting of VBC programs to track provider experience (tracking financial, operational, and quality metrics)
+ Financial modeling for financial impacts of various home health initiatives
+ Advanced analytics, trend detection, and deep-dive research to develop new metrics for our department
**Use your skills to make an impact**
**Required Qualifications**
+ Bachelor's Degree
+ Associate of Society of Actuaries (ASA) designation
+ Meets eligibility requirements for Humana's Actuarial Professional Development Program (APDP)
+ Member of the American Academy of Actuaries
+ Strong communication skills
+ Successful completion of at least 3 actuarial exams
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
**Preferred Qualifications**
+ Experience working in coding languages such as SAS and SQL
+ Prior Medicare Advantage or health insurance background
+ Additional skills developing reports and dashboards in Power BI
+ Ability to work in a fast-paced environment
**Additional Information**
+ This role is remote (work at home)
+ This role provides a unique opportunity to get hands on Medicare Advantage experience in a rapidly growing area outside of bid season
+ The role will primarily focus on leading the analysis and pricing of Value Based Care Contracts related to Home Health
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$106,900 - $147,000 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-21-2025
**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 ***************************************************************************
Senior TRICARE Community Liaison
Columbus, OH jobs
The Senior TRICARE Community Liaison (TCL) is a customer-facing Humana Military associate who is knowledgeable, professional, and courteous. This role interacts in person and by other means, such as by telephone, e-mail, and chat with TRICARE beneficiaries, Medical Treatment Facility (MTF) and other Government staff, including senior military leaders, and civilian healthcare providers and facilities. The primary focus of the Senior TCL is to develop and sustain strong, collaborative relationships with all TRICARE customers in the East Region - Government, beneficiaries, and providers. The Senior TCL must be cognizant of the military way of life during all interactions, including the impact of stress, trauma, and loss on active, reserve component and retired service members and their families that result from military operations. Assigned to specific Health System Areas comprised of Prime Service Areas (PSAs) and Non-Prime Service Areas (NPSAs) in a geography that may span over 43,000 square miles, the team's area of responsibility can include an average of more than 100,000 beneficiaries, 50,000-70,000 network and non-network providers, numerous National Guard/Reserve units, and three to four MTFs. Through clear and concise communication, the Senior TCL is responsible for ensuring MTF, beneficiary, and provider understanding of the TRICARE health plan and how to navigate the Military Health System. The Senior TCL also supports the Health System Leader in local TRICARE network operations, including participating in network development and optimization strategies which focus on a medically ready force and a ready medical force. The Senior TCL is self-directed and uses independent, critical decision-making in managing time, setting priorities, addressing general inquiries, and resolving both straightforward inquires and complicated problems and concerns raised by beneficiaries, providers, and Government customers. The Senior TCL may be designated as an embedded associate at an MTF and may be requested to provide back-up coverage in the absence of the Health System Leader. This position will require work during uncommon duty hours and travel to conduct outreach activities.
**KEY ACCOUNTABILITIES**
+ Provide accurate explanation of TRICARE health plan policies and procedures during on-site and electronic beneficiary, provider, and Government outreach activities, ensuring compliance with all customer support performance standards for the dual purposes of maximizing TRICARE customer satisfaction and the incentives paid by the Government, and of sustaining Humana Military's competitive advantage for future contracts.
+ Respond in precise, comprehensive and timely manner to beneficiary, provider, and Government inquiries regarding eligibility, enrollment, billing, claims, referrals/authorizations, network operations, access to care, Defense Health Agency/TRICARE Health Plan policy, and other TRICARE topics. Implement, track and complete self-managed tasks to process and correct uncomplicated general eligibility, enrollment, billing, claims, referral/ authorization, and network difficulties experienced by TRICARE customers.
+ Research and resolve difficult, complex TRICARE problems/issues elevated by a Government agent, beneficiary, or provider within required timelines. Implement self-directed activities to analyze, coordinate, process, and complete action to correct multifaceted problems relating to eligibility, enrollment, billing, claims, referrals/authorizations, network operations, access to care, Defense Health Agency/TRICARE Health Plan policy, and other TRICARE topics.
+ Assist in developing and sustaining a high-performing network in designated PSAs/NSPAs which meets TRICARE and Humana Government Business requirements and optimization strategies. Contribute in procuring the network discount goal assigned to each PSA/NPSA that results in annual financial incentives awarded by the Government. Conduct regular and ad hoc market laydown assessments to determine the capability and capacity of TRICARE providers, identifying and implementing action to address any gaps in the network.
+ Accomplish all administrative tasks as assigned, including documenting interactions, processing transactions, and submitting required reports.
+ Respond to and assist in contingency operations in support of the MTF and network as needed. Conduct urgent market laydown assessments to determine the capability and capacity of TRICARE providers, identifying and implementing action to accommodate changes in MTF services.
+ Participate in activities that promote well-being and professional growth of self and others.
**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)
+ **Will require living in Michigan, Indiana or Ohio, as this position will need to travel to locations in each of these states to provide briefings**
+ This position will require the ability to travel and work on weekends/nights as needed to provide briefings
+ Experience in customer relationship management, demonstrating courteous, professional interactions
+ Experience in analyzing information, researching problems, and determining and implementing solutions
+ Experience in healthcare provider relations
+ Exceptional public-speaking ability
+ Strong computer skills with business software
+ Superior organizational skills necessary to effectively manage multiple activities
**Preferred Qualifications**
+ Three to four years' experience in TRICARE, including presentations to groups
+ Knowledge of healthcare provider contract negotiations
**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
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.
**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 ***************************************************************************
Value Based Programs Lead
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Value-Based Programs Lead supports successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. The Value-Based Programs Lead provides strategic advice and guidance to functional team(s). Highly skilled with broad, advanced technical experience.
The Value-Based Programs Lead works with senior executives to develop and drive segment or enterprise-wide functional strategies with key national value-based provider partners. Advises one or more areas, programs or functions and provides recommendations to senior executives on matters of significance, and as an advanced subject matter expert, competent to work at very high levels in multiple knowledge and functional areas across the enterprise.
+ Advises market executives to develop functional strategies on matters of significance for provider contracting and performance management
+ Consults and leads the internal and external provider engagement strategy
+ Leads national joint operating committee with internal and external leadership
+ Possess a solid understanding of how organization capabilities interrelate across department(s)
**Use your skills to make an impact**
**Required Qualifications**
+ 3+ years of experience with provider performance management and/or value-based contracting
+ Strong understanding of key value-based financial components including revenue drivers, expense (DOFR) components, benefit and sales process.
+ Experience working with senior leadership
+ Experience facilitating cross departmental projects
+ Strong communication and presentation skills, including experience developing polished presentations to influence key decision makers
+ Strong project management experience on mid to large scale projects
+ Flexible, dynamic personality who works well in a team environment
**Preferred Qualifications**
+ Provider contracting and/or provider relations experience
+ Working knowledge of Service Fund reports
+ Advanced Degree (Bachelor's, Master's)
+ Experience with data extraction and analysis technologies
+ Experience preparing contracts and knowledge of Medicare and other reimbursement methodologies
+ Financial acumen with proficiency in analyzing and synthesizing provider financial trends into actionable insights
+ Solid experience building templates, standard documentation, and disseminating best in class knowledge
**Additional Information**
This role is "remote/work at home" and can be based anywhere in the United States.
**Work at Home Information**
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$104,000 - $143,000 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-11-2025
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
Bilingual Broker Agent Service Specialist - Hybrid in Multiple Locations
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. 2 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 1 of our target languages: Spanish, French, Mandarin, Cantonese, Tagalog, or Vietnamese
+ 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
Staff Utilization Management Clinical Pharmacist
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying evidence-based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors.
**_Earn a $5,000 hiring bonus!_** **Bonus is paid after 180 days of employment; you must be employed until that date to be eligible to receive the payment."**
**Location:** **Remote - United States**
**Schedule:**
+ 8-hour shifts, Monday through Friday, between 10:30 AM and 11:00 PM EST **OR**
+ 10-hour shifts, Tuesday through Friday, between 10:30 AM and 11:00 PM EST
+ Required to work **every 5th Saturday**
+ Required to work **1 company holiday per calendar year**
**Job Description:**
The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization, and identifying unusual usage patterns. The pharmacist may intervene and provide clinical guidance to patients and providers to support cost-effective medication use and promote high-quality patient outcomes.
**Use your skills to make an impact**
**Required Qualifications:**
+ **Bachelor's degree or Doctor of Pharmacy (Pharm.D.) from an accredited college of pharmacy**
+ Active pharmacist license in the state of residence
+ Eligibility to participate in federal prescription programs (e.g., Medicare/Medicaid)
+ Self-directed with the ability to work effectively both independently and in a team environment
+ Strong problem-solving skills and the ability to foster collaborative solutions
+ High attention to detail with a strong work ethic focused on accuracy and productivity
+ Excellent verbal and written communication skills
+ Proficiency with computer systems, including but not limited to:
+ Microsoft Office Suite (Word, Excel, Outlook)
+ Clinical decision support tools (e.g., Micromedex, Lexicomp)
+ Pharmacy benefit management (PBM) platforms
+ Electronic health records (EHRs)
+ Passion for contributing to an organization focused on continuously improving the consumer experience
**Preferred Qualifications:**
+ Experience in managed care pharmacy, particularly in utilization management review
**Additional Information:**
**Interview Format** : As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
**WAH Requirements:**
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
**SSN Statement:**
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$94,900 - $130,500 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-12-2025
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
Easy ApplyBusiness Intelligence Lead
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 ***************************************************************************
Principal, Stars Enterprise Activation - Insurance Operations
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Stars Enterprise Activation Principal coordinates, implements, and manages oversight of the company's Medicare/Medicaid Stars Program for aligned areas. The Stars Improvement Principal provides strategic advice and guidance to functional team(s). Highly skilled with broad, advanced technical experience.
This role is responsible for supporting the Stars strategy within Insurance Operations, serving as a subject matter expert for Stars-related initiatives, and ensuring their effective activation and integration throughout the Insurance Operations organization. Insurance Operations encompasses critical functions including care coordination, quality measurement, billing, claims processing, and customer service, each essential to delivering a comprehensive and high-quality member experience.
In this role, you will identify and engage with each area under Insurance Operations that has Stars-related initiatives to understand the business strategy, scope, and goals, building a working knowledge to inform identification and validation of potential synergies, business-specific requirements, risks, and integration paths. This role will collaborate with key Stars and segment business partners to monitor existing work, gain alignment on cross-asset integration opportunities, identify and implement new initiatives, and measure the value of the work. In addition, this role will support the inventory of existing Stars initiatives and help to identify gaps and opportunities for greater collaboration across segments. This role requires a deep understanding of operations and how it connects with enterprise Stars governance and initiatives.
**Role Responsibilities:**
+ Oversight of related budget, vendor relationships, and program/ project management
+ Serve as the primary liaison for Stars initiatives within Insurance Operations, building deep operational knowledge of core functional areas (care coordination, quality, billing, claims, and customer service).
+ Collaborate with each Insurance Operations function to identify, understand, and align Stars-related business strategies, objectives, and operational requirements.
+ Evaluate business processes across Insurance Operations to identify synergies, integration opportunities, and operational risks related to Stars performance and compliance.
+ Coordinate with analytics and reporting teams to generate actionable insights, enabling data-driven prioritization of operational improvements that directly impact Stars measures.
+ Partner with segment and enterprise Stars leaders to advance cross-functional initiatives, ensuring alignment between operational execution and Stars strategy.
+ Maintain a comprehensive inventory of Stars initiatives within Insurance Operations, identifying gaps and facilitating collaboration to maximize impact across all operational areas.
+ Lead and support the design, implementation, and optimization of Stars-related programs and processes within Insurance Operations, including performance monitoring and continuous improvement.
+ Oversee test-and-learn pilots to validate solutions and measure operational effectiveness, using results to inform broader implementation.
+ Develop and deliver regular reports on Stars operational performance to executive leadership, providing clear visibility into progress, challenges, and opportunities.
+ Manage budgets, vendor relationships, and project plans to support the successful delivery of Stars-focused operational initiatives.
**Use your skills to make an impact**
**Required Qualifications**
+ Bachelor's degree
+ 8-9 + years of quality improvement, developing & advancing enterprise strategy, insurance operations experience, i.e.: claims, UM, CM, call center, enrollment, etc.
+ 5 years or more of CMS Stars program experience
+ Medicare Advantage experience
+ Previous leadership experience as a people leader, leading through influence, or leading complex projects with engagement from multiple areas of the company
+ Demonstrated track record of ability to tell the story, influence leaders and drive improvement activity in a matrixed organization
+ Strong executive presence
+ Ability to navigate business intelligence tools to review data insights & making data driven decisions
+ Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and PowerPoint
**Preferred Qualifications**
+ Master's Degree
**Additional Information**
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
+ Satellite, cellular and microwave connection can be used only if approved by leadership
+ Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$138,900 - $191,000 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-18-2025
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
Easy ApplyMedical/Financial Risk Evaluation Professional 2
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 ***************************************************************************
Special Needs Plan- Support Social Services
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 ***************************************************************************
Easy ApplyPhysician Resident- Pathways| Unity Health Network
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_
Encounter Data Management Lead
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Encounter Data Management Lead supports the Encounter Data Management team within the Healthcare Quality Reporting and Improvement (HQRI) organization. This position is responsible for ensuring the accurate and timely submission of encounter data to Medicaid, Medicare, and DSNP states, while maintaining adherence to all regulatory requirements. The Lead utilizes strong analytical skills and attention to detail and collaborates effectively with cross-functional teams to drive process improvements and enhance communication and collaboration across the organization.
The Encounter Data Management Lead is responsible for ensuring the integrity and accuracy of Medicaid and Medicare encounter data across multiple trading partners. This role collaborates with Product Owners and business contract owners to facilitate accurate and compliant encounter data submissions. The Lead manages the resolution of complex data issues while supporting business contract teams across multiple trading partners.
**Use your skills to make an impact**
**Required Qualifications**
+ Minimum of 2 years' professional experience in Medicaid data management, healthcare operations
+ Ability to monitor product performance, resolve production environment issues, and communicate timely updates to business stakeholders.
+ Strong ability to facilitate effective meetings, lead collaborative discussions, and clearly communicate project status, issues, and solutions to business stakeholders.
+ Knowledge in Agile ceremonies, including backlog refinement, sprint planning, and Program Increment (PI) planning.
+ Proficiency in Azure DevOps, including experience reviewing high level testing activities.
+ Demonstrated ability to lead cross-functional collaboration and foster effective team engagement.
+ Exceptional interpersonal and relationship-building skills, with the ability to engage and influence diverse stakeholders, including technical teams and business partners.
+ Ability to translate complex data findings into clear, actionable business recommendations for non-technical audiences.
+ Experience delivering professional presentations, reports, and documentation to support cross-functional initiatives and decision-making.
+ Experience using SQL and data analytics tools to track, trend, and resolve data issues.
+ Demonstrated authority to define product direction, with a consistent focus on advancing key business objectives.
**Preferred Qualifications**
+ Lean or Six Sigma certification.
+ Hands-on experience in encounter data submissions
+ Background in Medicare and/or Medicaid product management or support.
+ Familiarity with Claims Adjudication Systems (CAS).
+ Knowledge of X12 transaction sets and standards.
+ Proficiency in SQL for data analysis and management.
**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, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$94,900 - $130,500 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-15-2025
**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 ***************************************************************************
Medical Director - Post-Acute Care Management - Care Transitions - Remote
Cleveland, OH jobs
Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere.
As a team member of our navi Health product, we help change the way health care is delivered from hospital to home supporting patients transitioning across care settings. This life-changing work helps give older adults more days at home.
We're connecting care to create a seamless health journey for patients across care settings. Join us to start **Caring. Connecting. Growing together.**
**Why navi Health?**
At navi Health, 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. navi Health 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 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
**California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington** **or** **Washington, D.C. Residents Only:** The salary range for this role is $286,104 to $397,743 annually. Salary Range is defined as total cash compensation at target. The actual range and pay mix of base and bonus is variable based upon experience and metric achievement. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, 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._
_Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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._
_UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._
Technology Solution Implementation Professional
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Technology Solution Implementation Professional delivers new technological solutions to meet business needs within a specified scope while aligned to enterprise objectives. The Technology Solution Implementation Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
**Role Description:**
Support Medicaid Implementations and Operations in electronic transmissions set-up for state regulatory partners, health information exchanges, and vendor partners.
**Responsibilities:**
Works with ETL developers, data stewards, project managers, and business SMEs to obtain programming specifications needed to submit information in our proprietary ticketing system that moves data from its origin to its ultimate destination.
+ Ensures proper documentation is completed so that the programming and testing occurs
+ Tracks and maintains documentation on ET work
+ Communicates between both IT and non-IT departments on updates, as well as educating non-IT departments on the process
+ Ensures proper access for authorized users and provides support to data tool users
+ Conducts connectivity testing when needed
+ Coordinates establishing connections to SFTP sites in collaboration with the State Technology Market Lead
+ Coordinates resolution of resolving ETL issues for the market
+ Participates on vendor and market calls when necessary
+ Produces reports and analytics outlining progress and resolution
+ Maintains inventory of market ET transmissions
+ Other duties as assigned
**Use your skills to make an impact**
**Required Qualifications**
+ Two years + experience using technology in data analysis projects or in projects that dealt with business data flows.
+ 1 + years of ETL experience.
+ Demonstrated understanding of the information needs and processing flows in healthcare environments
+ Experience with the SDLC phases of a project and general knowledge of project management.
+ Demonstrated excellent written and verbal communication skills.
+ Demonstrated ability to maintain confidentiality, follow directions, and use good judgment in an environment that can be ambiguous and time sensitive.
+ Ability to work EST
+ SFTP Experience
+ Process Improvement
**Preferred Qualifications:**
+ Power BI, Jira and ADO training preferred
+ Experience with Agile Methodology and/ or Scaled Agile Methodology
+ Experienced in introducing new processes into a new or existing environment while minimizing disruption and mitigating risks
+ Experience with Medicare and/or Medicaid
+ Ability to coordinate with development and user teams to assess risks, goals, and needs and ensure that all are adequately addressed
+ Bachelor's degree in CS, Engineering, Math, Information Systems, Data Science, Data Analytics, or Statistics
**Additonal Information**
Candidates should be prepared to work outside regular hours when required to meet essential timelines.
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA informatio
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$60,800 - $82,900 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
**Description of Benefits**
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-14-2025
**About us**
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
**Equal Opportunity Employer**
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
Mental Health Therapist - LISW, LPCC or LMFT
Columbus, OH jobs
**Optum Behavioral Care, part of the Optum family of businesses is seeking a Mental Health Therapist to join our team in Columbus, OH. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Behavioral Care Team, you'll be an integral part of our vision to make healthcare better for everyone.**
The **Licensed Therapist** is responsible for providing direct clinical services to patients in the Collaborative Care Model (CoCM) in a primary care clinic, and will operate in conjunction with Optum Behavioral Care (OBC) to serve as the core member of the hybrid in-person/virtual collaborative care team for OBC clients.
In this cutting-edge team the Therapist will interface between patients, PCPs, and psychiatrists to support the mental health and physical health care of patients on an assigned patient caseload from OBC clients. The Therapist will have the support of OBC's clinical and operational teams. This is an ideal role for you if you want to be at the center of an innovative model that can successfully improve the wellbeing for patients, you are interested in being part of a fast-growing company, and you thrive in a team environment.
This role will be embedded within our healthcare client; **American Health Network Clinics.** This is a Monday-Friday role, with no evenings, weekends, holidays.
**_As part of this hybrid role, you will work remotely one or two days per week, with the other days being onsite at the medical clinic._**
**Why Optum Behavioral Care**
We are committed to your well-being and growth, offering a comprehensive package of perks and benefits with varying eligibility based on role, including:
+ Competitive salary
+ Flexible work models & paid time off when you need it
+ Health and well-being benefits like health insurance, 401k matching, and other family support and wellness resources
+ Professional development with tuition reimbursement and dedicated learning time to advance your career
+ CE/CEU and licensure renewal reimbursement
**Position Highlights & Primary Responsibilities:**
+ Use virtual and in-person modalities to coordinate care with the patient's medical provider and, when appropriate, other mental health providers
+ Screen and assess patients for common mental health and substance abuse disorders
+ Systematically track treatment response and monitor patients for changes in clinical symptoms and treatment side effects or complications
+ Support psychotropic medication management as prescribed by medical providers, focusing on treatment adherence monitoring, side effects, and effectiveness of treatment
+ Provide brief behavioral interventions using evidence-based techniques such as behavioral activation, problem-solving treatment, motivational interviewing, or other treatments as appropriate
+ Participate in regularly scheduled caseload consultation with the psychiatric consultant and communicate resulting treatment recommendations to the patient's medical provider
+ Develop and complete relapse prevention self-management plan with patients who have achieved their treatment goals and are soon to be discharged from the caseload
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:**
+ Meet one of the following license requirements for the state of Ohio:
+ Licensed Independent Social Worker (LISW) or Licensed Professional Clinical Counselor (LPCC)
+ Licensed Marriage and Family Therapist (LMFT)
+ 3+ years of experience treating patients (pediatrics and adults) with behavioral health conditions
+ 1+ years of experience working in primary care or other medical behavioral integrated setting (i.e., with other provider types)
+ Experience with assessment and using evidence-based psychosocial treatments and brief behavioral interventions for common mental health disorders (e.g., cognitive behavioral therapy, motivational interviewing, problem-solving treatment, behavioral activation
**Preferred Qualifications:**
+ Experience in the Collaborative Care Model (CoCM)
+ Demonstrated experience being detail-oriented, organized, and have exceptional follow-up capabilities
+ Proven ability to maintain effective and professional relationships with patient and other members of the care team
+ Proven ability to work with patients in person as well as by telephone and video
+ Proven solid grasp of technology solutions and tools and ability to adapt
+ Bi-lingual Spanish
**Explore opportunities at Optum Behavioral Care.** We're revolutionizing behavioral health care delivery for individuals, clinicians and the entire health care system. Together, we are bringing high-end medical service, compassionate care and industry leading solutions to our most vulnerable patient populations. Our holistic approach addresses the physical, mental and social needs of our patients wherever they may be - helping patients access and navigate care anytime and anywhere. We're connecting care to create a seamless health journey for patients across care settings. Join our team, it's your chance to improve the lives of millions while **Caring. Connecting. Growing together.**
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 $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
_OptumCare 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._
_OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._
Community and State Community Initiatives Director - Ohio Market - Remote
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._
Anaplan OWP Software Engineer
Columbus, OH jobs
**Become a part of our caring community and help us put health first** Software Engineer for Anaplan focuses on building and enhancing the core platform capabilities that support high-throughput workloads, AI-powered insights, and efficient data flows to meet the business needs.
This role is responsible for developing resilient, observable, and scalable systems, often using technologies like cloud-native tools. This role involves full-stack development, including front-end and back-end components, and requires a strong emphasis on clean, maintainable, well-tested code with a focus on performance and reliability.
Key Responsibilities:
+ Building and maintaining core platform capabilities that support various workloads for buisness
+ Developing data integrations with data lakes, event stores, and analytics systems.
+ Contributing code to both front-end and back-end components
+ Quality and well-tested code with a focus on performance and reliability.
+ Participating in design reviews and technical discussions
+ Coordinating technical deliverables across sprint cycles and collaborating with cross-functional teams, including those in other time zones. Ensuring the platform is scalable, observable, and resilient.
+ Utilizing cloud-native tools and services to build and deploy the platform.
**Use your skills to make an impact**
**Required Qualifications**
+ Anaplan OWP implementation experience and understanding of other Anaplan modules
+ Experience with cloud platforms and services.
+ Excellent problem-solving and communication skills.
+ Experience with DevOps principles and practices.
+ Experience with data engineering and data processing pipelines is a plus.
+ Experience with cloud infrastructure and cost optimization is a plus.
+ Bachelor's Degree in Computer Science or related field
+ 5 years of experience in systems analysis or application programming development
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
**Preferred Qualifications**
+ Master's Degree
**Additional Information**
**Work-At-Home Requirements**
+ WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.
+ A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.
+ Satellite and Wireless Internet service is NOT allowed for this role.
+ A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information\#LI-Remote
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
**Scheduled Weekly Hours**
40
**Pay Range**
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$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: 12-15-2025
**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 ***************************************************************************
Senior Corporate Director of Pharmacy - Remote
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 **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 at 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 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.
**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._
Pharmacy Fellow - Health Equity and Systems Thinking
Columbus, 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.**
The CPS Solutions, LLC Health Equity and Systems Thinking Pharmacy Fellowship is aimed to position our graduates to improve health equity through advocacy, recognition of systems thinking, and adoption of community resources/partnerships to improve chronic conditions. You will focus on addressing and improving healthcare disparities with the aim of a more culturally and competent pharmacist workforce in integrating social determinants of health screening and interventions into medication use encounters and improving patient outcomes. This is a 12-month position only. Additional time may be added as needed and will be determined by the end of the term.
**The Pharmacy Fellowship is a 12-month, full-time program starting in August 2026 with the schedule being a minimum of 40 hours per week, Monday - Friday, and occasional weekends as needed.**
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
**Primary Responsibilities:**
+ Analyze an assessment that incorporates structural and process of care indicators to improve health literacy and communication between pharmacy and patients during the medication management encounter
+ Collect and analyze patient population data for the health system or organization
+ Collaborate with departmental and/or interdisciplinary teams in the design, implementation, and/or enhancement of the organization's criteria for appropriate medication use management
+ Increase knowledge about social determinants of health (SDOH) and disparities in health care and explore attitudes and behaviors that promote and/or mitigate disparities in patient care
+ Conduct a longitudinal research and quality improvement project for presentation at a professional platform
+ Assess the health system (or department) for components of health literacy
+ Implement systems thinking-based evaluation design and intervention design
+ Evaluate opportunities for improving patient outcomes, clinical and operational efficiencies, safety and quality of the medication-use process through the application of Continuous Quality Improvement (CQI) strategies
+ Develop a structural Certificate Program in the area of health equity, disparity and systems thinking for preceptors and pharmacist leaders
+ Assist the organization in achieving compliance with accreditation, legal, regulatory, and safety requirements related to the use of medications (e.g., appropriate accrediting bodies and related professional organization standards, statements, and/or guidelines; state and federal laws regulating pharmacy practice)
+ Provide effective medication and practice-related education to health care professionals in health equity standards and systems thinking
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:**
+ Minimum of a bachelor's degree from an American Council on Pharmaceutical Education (ACPE) accredited college or university (PharmD preferred)
+ Licensure in good standing as a Registered Pharmacist prior to the program start date; willingness to reciprocate
+ Post-graduate pharmacy residency (PGY1) or equivalent training
+ Must include curriculum vitae (CV), a personal letter of intent, transcript and the names and contact information of three individuals that can provide professional letters of recommendation as part of the application
+ Driver's License and access to reliable transportation
**Preferred Qualifications:**
+ Doctor of Pharmacy (PharmD)
+ Degree in Public Health or work experience in public health services
+ Possess necessary knowledge to provide oversight of medication regimens for the patient populations treated in the facility, including a knowledge of dosing for specific age populations
+ Proven effective interpersonal and communication skills - verbal and written
+ Proficiency with pharmacy computer systems
+ Proficiency with Outlook, Word, PowerPoint and Excel
+ Ability to collaborate effectively with all levels across the organization.
*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 $71,200 to $127,200 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._