VetCor Remote jobs - 75 jobs

Manager, Customer Success - IFG
Humana 4.8
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Customer Success Manager is a key leadership role responsible for ensuring customer retention through proactive engagement, strategic initiatives, and operational excellence. This role works collaboratively to ensure alignment and consistent performance, managing up to 25 Customer Success Agents to deliver on retention objectives and test new business initiatives. The Customer Success Manager plays a critical role in driving customer retention through proactive engagement with customers and the implementation of strategic retention initiatives. In addition to core retention campaigns and allegation mitigation, the role supports Call Quality for their team, contributes to broader enterprise value by test & learning new initiatives, and can be part of building something from the ground up. The Customer Success Manager should be ready to receive objectives and determine approach, resources, goals, and measure success. The Customer Success Manager will work closely with the AVP, Growth & Operations, and cross-functional teams to drive strategic priorities and provide valuable insights to support decision-making. As a critical link between associates, peers, and senior leadership, the Customer Success Manager fosters a culture of accountability, collaboration, and continuous improvement within the team and across the organization. **Driving Retention Campaigns and Initiatives** + Leads retention-focused initiatives, such as targeted outreach campaigns, ensuring associates understand their role in its success + Oversees the roll out of enterprise value initiatives vital to a new and growing business model **Strategic Collaboration and Leadership** + Partners with the AVP and peer leaders to align team strategies with broader organizational goals and retention objectives + Facilitates cross-team collaboration to share best practices, resolve challenges, and ensure consistent approaches to customer engagement + Represents the team in strategic discussions, providing insights and recommendations based on team performance and customer feedback **Empowering Associates and Building a Supportive Team Culture** + Creates an inclusive, supportive culture where associates feel valued, motivated, and encouraged to share ideas and collaborate to achieve team goals + Empowers associates to identify any customer concerns independently, providing clear guidance, tools, and support to build confidence and autonomy + Demonstrates effective communication, accountability, and solutions-oriented mindset to inspire associates and cultivate a high performing team **Coaching and Performance Management** + Creates a cohesive team with one goal: be the best advocate for our customers + Provides ongoing coaching and training to equip associates with the skills, tools, and confidence needed to achieve retention goals and deliver exceptional member experiences (i.e. Call Quality) + Uses key metrics and KPIs to track individual and team performance, addressing gaps with targeted improvement plans and celebrating success to maintain motivation + Conducts regular one-on-one sessions to set clear goals, provide constructive feedback, and support professional development **Administrative Responsibilities** + Communicates policies, schedules updates, and time-off guidance effectively + Oversees timekeeping and scheduling, including timesheets, managing employee schedules, and ensuring adequate coverage during absences + Monitors attendance, punctuality, and overtime **Use your skills to make an impact** **Required Qualifications** + Health Insurance Licensure in resident state + 3+ years working in healthcare insurance or a related industry + 3+ years of formal/informal leadership experience + Proven ability to coach and develop team members, driving performance and accountability + Strong analytical skills with experience tracking and improving key performance metrics (examples: call outcomes, retention, accretion, NPS, etc.) + Excellent interpersonal and communications skills, with the ability to influence and collaborate across teams and leadership levels + Demonstrated success in managing initiatives or campaigns to achieve strategic goals. + Commitment to recruiting and developing diverse talent to meet the dynamic business requirements of the market + Ability to travel up to 20% of the time for leadership/business meetings + Available to work shifts that could fall between the business hours of 7:00 am to 11:00 pm local time, that include nights, weekends, or any additional hours based on business need + Growth / Continuous Improvement Mindset **Preferred Qualifications** + Associate or Bachelor's Degree + Start Up or Innovation Experience + Prior experience in sales and/or leading a sales team + Familiarity with CRM tools (SalesForce) or data visualization tools (PowerBI) used for performance tracking and reporting + Change Management certification + Bilingual proficiency **Additional Information** **Virtual Pre-Screen** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn't missed) inviting you to participate in a HireVue interview. In this interview, you will listen to a set of interview questions over your phone or text and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide their social security number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. **Work-At-Home 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 Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $86,300 - $118,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-11-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$86.3k-118.7k yearly Easy Apply 6d ago

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Consumer Experience Professional
Humana 4.8
Toledo, OH jobs
Become a part of our caring community and help us put health first Humana's Highly Integrated Dual Eligibility Special Needs Plan (HIDE SNP) in Michigan is seeking a Consumer Experience Professional 2 who will ensure optimized interaction between Humana and our members. The Consumer Experience Professional will work assignments that are varied and frequently require interpretation and independent determination of the appropriate courses of action. Partner across consumer services areas to ensure excellence with functions such as market Care Management teams, member services, enrollment and eligibility, the State Agency (MDHHS), Adult Protection Services, and call center operations. Leverages the voice of the customer, NPSt, Care and/or Service Coordination team feedback, market or regulatory compliance information, Grievance and Appeal information, call listening, member experience design, elimination and recognition of friction points, identifying automation/optimization opportunities, empower others in the organization to speak up and voice opportunities to improve the member experience. Functions as the single point of contact and specifically responsible for coordination with Adult Protective Services (APS), the justice system, Member Support Services contractor, and Long-Term Care (LTC) ombudsman. Understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Make decisions regarding own work methods, occasionally in ambiguous situations, and require minimal direction and receives guidance where needed. Follow established guidelines/procedures. Use your skills to make an impact Required Qualifications Must reside in Michigan or within a 40-mile radius of the Michigan border in the neighboring states of Indiana or Ohio. Two (2) or more years of experience in consumer operations. Proficiency in all Microsoft Office Programs including Word, PowerPoint, Excel, and Access. Ability to interpret assignments and understand department strategy (understanding the members needs and determining strategy for care). Experience making decisions and working independently with little supervision. Excellent time management skills, quick learner and a self-starter. Comfortable working in a fast-paced environment. Demonstrates confidence in speaking in a variety of meeting forums. This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. Ability to travel to region-based community centers. This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individuals must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher. Preferred Qualifications Bachelor's degree or equivalent experience. Previous experience working with State associates or judicial systems. Call Center Leadership or provider engagement experience is a plus. Dual-Eligible Medicare/Medicaid knowledge. Project Management Knowledge. Additional Information Workstyle: This is a remote position with travel. Travel: Up to 25% travel across Michigan to meet community partners, and various care teams. Occasional travel to Humana's Detroit office is also expected for team engagement meetings. Typical Workdays and Hours: Monday - Friday; 8:00am - 5:00pm Eastern Standard Time (EST). WAH Internet Statement To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $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.
$59.3k-80.9k yearly Auto-Apply 21d ago
Inpatient Medical Coding Auditor
Humana 4.8
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. 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** **WORK STYLE:** Remote/work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **WORK HOURS:** Typical business hours are Monday-Friday, 8 hours/day, 5 days/week, scheduled between 6AM-6PM. Some flexibility might be possible, depending on business needs. **Required Qualifications | What it takes to Succeed** - RHIA, RHIT or CCS Certification (should have held at least one of these qualifications for 4 years) - MS-DRG coding/auditing experience - Experience reading and interpreting claims - Experience in performing inpatient coding reviews/ audits in health insurance and/or hospital settings - Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel - Strong attention to detail - Can work independently and determine appropriate course of action - Ability to handle multiple priorities - Capacity to maintain confidentiality - Excellent communication skills both written and verbal **Preferred Qualifications** - Experience in APR DRG coding/auditing - Experience in Financial Recovery - Experience in a fast paced, metric driven operational setting **Additional Information** **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 **Interview Format** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire 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. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. 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: 01-12-2035 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$71.1k-97.8k yearly 21d ago
Associate Actuary - Enterprise Growth Finance
Humana 4.8
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Associate Actuary will be a key member of the Enterprise Growth Finance team. The Associate Actuary analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Establishes metrics, provides data analyses, and works directly to support business intelligence. Evaluates trends to forecast the organization's short, medium and long-term financial position. The Associate Actuary's work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Associate Actuary will work as part of the Enterprise NPV team under Enterprise Growth Finance. The Associate Actuary ensures data integrity by developing and executing necessary processes and controls around the flow of data and associated modeling. Collaborates with stakeholders to understand business needs/issues, troubleshoots problems, conducts drilldown analysis, and develops resolutions for data anomalies. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. The Associate Actuary will focus primarily on: + LTV/NPV Modeling - Maintenance and enhancement of MA-IND NPV models, and creation of NPV modeling for CenterWell lines of business + Ad Hoc Analysis - Deep-dives into NPV modeling to provide new insights needed for utilization of the model in business situations **Use your skills to make an impact** **Required Qualifications** + Bachelor's Degree + Associate of Society of Actuaries (ASA) designation + MAAA + Strong communication skills, with experience in collaborative work across functions + Advanced Excel and SAS/SQL skillset + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + Prior Humana MA and/or CenterWell experience + Prior Experience with LTV/NPV modeling + Databricks and Power BI experience **Additional Information** This position can work from home from anywhere in the US. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $106,900 - $147,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-30-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$106.9k-147k yearly 28d ago
Utilization Management Behavioral Health Professional 2
Humana 4.8
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. **Role Responsibilities** Tasks include, but are not limited to: **70%:** Performing utilization management activities for assigned areas. Ensures full compliance with contract requirements, policies and procedures, and performance standards. Coordinates and implements contingency operations when needed. + Perform accurate and timely initial and ongoing treatment reviews with documentation in MSR reflecting determination of appropriateness of level of care according to established Humana Government Business contractual requirements and guidelines. + Uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, understanding moderately complex to complex issues and policies and procedures to determine the best and most appropriate treatment, care, or services for ACD participants. + Review ABA TPs for policy compliance + Review pend queues for pended authorizations + Approve clinically necessary and appropriate ABA services + Review outcome measures to ensure compliance with ACD policy + Coordinates, conducts outreach, and communicates with providers, beneficiaries, or other parties to facilitate optimal care and treatment, when necessary, to educate and address clinical necessity concerns and ACD policy compliance requirements. + Facilitating communication as needed between all departments within Humana Government Business and Humana corporate to resolve escalated issues and ensure the enterprise understand the function of the ACD team. Understanding and engaging in risk management procedures and analysis. + Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas, as well as need for overtime, weekend, and holiday coverage when necessary to maintain contractual performance standards for referral and authorization processing. **15%:** Collaborate with all Humana operations departments to operate and improve processes related to specialty team(s) effectiveness with the highest degree of attention to beneficiary and provider experience. + Optimize staff productivity surrounding process management. + Strategical look for interventions and methods to improve performance. **10%:** Strategize with all leaders within the ACD team and Specialty team to make recommendations to the DHA or Humana Government Business to improve policy which may relate to better case management outcomes, improved utilization management, prevention or identification of fraud waste and abuse, and trend data. **5%:** Other tasks as assigned **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) + HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico. + BCBA (Board Certified Behavior Analyst) Certification + 3 or more years of experience as a Board-Certified Behavior Analyst + 3 or more years of applied behavioral analysis (ABA) with ASD (Autism Spectrum Disorder) experience + Proficiency in Microsoft Office programs specifically Word, Excel, and Outlook + Ability to handle multiple projects simultaneously and to prioritize appropriately **Required Work Schedule** + Training is mandatory for the first 4 - 6 weeks from 8:00 AM - 5:00 PM Eastern time, Monday - Friday. + Following training, must be able to work an 8-hour shift between the hours of 8:00 AM - 6:00 PM Eastern time, Monday - Friday. + Overtime, weekends, and holidays may be required, based on business needs. **Preferred Qualifications** + Prior experience with the TRICARE Autism Care Demonstration + Knowledge of and experience with applied behavior analysis and integrated care needs for those with autism + Prior experience with Utilization Review, Utilization Management, Peer Reviews and/or Quality Management + Knowledge of CPT codes that apply to ABA and/or experience with DMS-5 criteria + Prior experience with outcome measure assessments to include PDDBI, Vineland, SRS and/or PSI-SIPA + Experience with interpreting medical policy + Direct or indirect military experience a plus **Work at Home Guidance** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. + **Satellite and Wireless Internet service is NOT allowed for this role** + 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. $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. **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$65k-88.6k yearly 3d ago
Bilingual (English/Tagalog) Broker Agent Service Specialist - Hybrid in Multiple Locations
Unitedhealth Group 4.6
Dublin, OH jobs
**$1,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS** At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts on the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together.** Positions in this function provide support for our year-round Language Strategy by supporting consumers with specific Language needs through end-to-end call handling or acting as an interpreter based on license status. The Team also supports our Group Retiree Consumers in a Sales Support capacity to provide education to Retiree's who are offered custom plan benefits. This position is full - time (40 hours / week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (7:00am to 10:00pm CST). It may be necessary, given the business need, to work occasional/mandatory overtime that could include a Saturday. This is a Hybrid role - working a combination of onsite and at home. 3-4 days are required in office per week. **Work Locations:** + Phoenix, AZ: 430 North Scottsdale Road, Tempe, AZ 85288 + Minnetonka, MN: 9800 HEALTH CARE LANE, MINNETONKA, 55343 + Miami, FL: 1000 NW 57th Court, Miami, FL, 33126 + De Pere, WI: 2020 Innovation Court, De Pere, WI + Colorado Springs, CO: 9945 Federal Drive, Colorado Springs, CO + Englewood, CO: 169 Inverness Drive, Englewood, CO + Maryland Heights, MO: 13655 Riverport, Maryland Heights, MO + Roanoke, VA: 3645 Thirlane Road NW, Roanoke, VA + Dublin, OH: 5900 Parkwood Place, Dublin, OH If you are located within a commutable distance to any of the above locations, you will enjoy the flexibility of a hybrid-remote position* as you take on some tough challenges. **Primary Responsibilities:** + Primary support for consumers and members needing in-language support + Support inbound call volume with potential for occasional outbound for consumers and members + Provide education during Q3 and Q4 for Group Retiree inbound call volume + Uptrained to support Group Retiree prospective member chats through LivePerson technology. This includes completing enrollment applications through LivePerson as applicable. This is an uptraining after 1 year in the role and based on license status + Flexible and ability to adapt to special projects/campaigns to support year-round business needs. + Use knowledge of Medicare product portfolio to accurately assess the distinct needs of different prospects, explain the differences between various products and assist the prospective member in selecting a product that best meets their unique needs + Accurately and thoroughly complete and submit required documentation, consistent with Medicare requirements and guidelines + Meet and maintain requirements for agent licensure, appointments, and annual product certification You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + High School Diploma/GED (or higher) OR 6+ months of customer service/sales experience + Health insurance license in state of residence OR ability to obtain within 6 months of starting employment + Intermediate level of proficiency with computer and Windows PC applications, including the ability to learn new and complex computer systems and apply for phone and off-phone activity + Ability to read, write, and speak fluently in English and our target language: Tagalog + Flexibility to work assigned shift within the hours of operation (Monday - Friday 7am - 10pm CST) **Soft Skills:** + Ability to type and talk at the same time and navigate through multiple screens + Ability to follow outlined process and business expectations + Ability to multi-task in a fast-paced environment + Comfortable navigating between multiple computer systems running concurrently to search and share information with the consumer + Flexible to workflow changes and alter course when appropriate + Open to coaching and development + Ability to successfully field inbound and outbound calling campaigns + Consumer centric mindset **Telecommuting Requirements:** + Reside within Minnetonka, MN, Miami, FL, OR Phoenix, AZ + Required to have a dedicated work area established that is separated from other living areas and provides information privacy + Ability to keep all company sensitive documents secure (if applicable) + Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. ****PLEASE NOTE** The sign-on bonus is only available to external candidates. Candidates who are currently working for UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus.** Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._ \#RPO #YELLOW
$20-35.7 hourly 32d ago
Senior Cloud Solutions Engineer
Humana 4.8
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Senior Cloud Solutions Engineer participates in the design and development of cloud-based solutions and applications in the big data space within Humana's Digital & Data organization primarily using Microsoft Azure and related technologies. The Senior Cloud Solutions Engineer work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Cloud Solutions Engineer implements the organization's cloud strategy from a technical perspective, including design, planning, integration, and maintenance for big data solutions using Microsoft Azure. This will involve participating in the design and development of cloud-based solutions and applications within Humana's Digital & Data organization primarily using Microsoft Azure. Responsibilities Include: + Work with stakeholders across organization to evaluate cloud systems and identify appropriate solutions. + Collaborates with product managers and engineers to develop specifications for new cloud-based products/services, applications and solutions. + Drives the roll-out of cloud management platforms, evaluates its performance and implements enhancements. Begins to influence department's strategy. + Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree in Computer Science, a related field, or equivalent professional experience. + Proven experience designing and implementing cloud-based big data solutions using Azure, AWS, or GCP. + Minimum of 6 years of experience in cloud application design, development, and testing. + At least 3 years of hands-on experience working with Databricks, Azure Data Factory, and Azure Synapse Analytics. + Proficient in ETL processes, SQL, and PySpark for data integration and transformation tasks. + Experience with version control systems (such as Git) and managing release pipelines. + Demonstrated commitment to enhancing consumer experiences and supporting continuous organizational improvement. + One or more professional certifications in Azure, Databricks, or other major cloud platforms. **Preferred Qualifications** + Master's Degree + Databricks experience + Python experience **Work-At-Home Requirements** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested + Satellite, cellular and microwave connection can be used only if approved by leadership + Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $106,900 - $147,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-13-2026 **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 ***************************************************************************
$106.9k-147k yearly 60d+ ago
Senior Coding Educator
Humana 4.8
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Senior Coding Educator identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. The Senior Coding Educator is responsible for creating and executing the risk adjustment strategy for each provider groups. + Analyzes data and reporting and provides educational sessions with providers aimed at quality of care, documentation and coding improvements. + Collaboration with relationship owners and HQRI + Research data and workflow processes and arranges educational sessions with providers aimed at quality of care and documentation improvements. + Monitor and develops strategy with Coding educator and leader, tailor's provider group webinars and discussions based on various Risk Adjustment topics. **Use your skills to make an impact** **Required Qualifications** + AAPC CPC (Certified Professional Coder) Certification + 2 or more years of medical record review knowledge + 2 or more years of risk adjustment provider education + Familiar with coding guidelines (i.e. ICD-9/ICD-10) + Comprehensive knowledge of MS Word, Excel and PowerPoint + Analyzing Data to drive process improvement + Experience with public speaking and presentation skills **Preferred Qualifications** + Bachelor's degree + Certified Risk Coder (CRC) + Experience interacting with healthcare providers + Ability to work independently + Medicare Risk Adjustment knowledge + Analyzing data to build unique education strategies in PowerBi **Additional Information** **Department Hours: 7am to 5pm EST** Work at home - with ability to travel (up to 25% to surrounding provider offices) **Additional Information** As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. **Work at Home Guidance** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested + Satellite, cellular and microwave connection can be used only if approved by leadership + Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker. \#LI-BB1 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$71.1k-97.8k yearly 21d ago
Manager, Fraud and Waste, Special Investigation Unit-Triage
Humana 4.8
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Manager, Fraud and Waste conducts investigations of allegations of fraudulent and abusive practices. The Manager, Fraud and Waste works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. **Where You Come In** The Manager, Fraud and Waste coordinates investigation with law enforcement authorities. Assembles evidence and documentation to support successful adjudication, where appropriate. Conducts on-site audits of provider records ensuring appropriateness of billing practices. Prepares complex investigative and audit reports. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department. **What Humana Offers** We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent professional development & continued education. **Use your skills to make an impact** **Required Qualifications - What it takes to Succeed** + Bachelor's Degree + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of experience with Fraud, Waste, and Abuse in either a Managed Care or a government setting + Minimum 3 years of proven leadership skills and significant experience directly managing a group of seasoned professionals. + Proven knowledge in Medicare regulations + Excellent PC skills MS Excel and Access and PowerPoint required + Excellent communication skills, written and verbal + Strong organizational and project management skills + Strong Analytical skills + Core business hours align to Eastern Standard Time (EST) + Able to analyze large amount of data + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + Certifications (BA, MBA, J.D., MSN, Clinical Certifications, CPC, CCS, CFE, AHFI) + Understanding of healthcare industry, claims processing and internal investigative process development + Experience in a corporate environment and understanding of business operations **Additional Information - How we Value You** + Benefits starting day 1 of employment + Competitive 401k match + Generous Paid Time Off accrual + Tuition Reimbursement + Parent Leave **SSN Alert Statement** Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. **WAH Internet Statement** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. 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: 01-20-2026 **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 ***************************************************************************
$34k-49k yearly est. Easy Apply 20d ago
Senior Technology Solutions Professional - AI and Automation
Humana 4.8
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Senior Technology Solutions Professional devises an effective strategy for executing and delivering on IT business initiatives. The Senior Technology Solutions Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. **Job Title:** Senior Technology Leader - AEP Readiness & Automation **Location:** Louisville, KY / Remote **Department:** Technology Solutions **Reports To:** Director, Technology Solutions **Position Overview:** Humana is seeking an accomplished Senior Technology Leadership Professional to drive AEP (Annual Enrollment Period) readiness, leveraging automation to optimize and streamline key business processes. This leader will partner with cross-functional teams to ensure all technology platforms, DevOps practices, and automation initiatives are aligned with organizational goals and compliance requirements, fostering continuous improvement and operational excellence. **Key Responsibilities:** + Lead the technology strategy for AEP readiness initiatives, ensuring high availability, scalability, and resilience of critical systems. + Collaborate with Product, Operations, and Compliance teams to define requirements and deliver solutions that meet regulatory and business needs. + Architect and implement automation frameworks to streamline processes, reduce manual interventions, and accelerate delivery timelines. + Mentor and guide technology teams in the adoption of new tools and practices, fostering a culture of innovation and accountability. + Ensure comprehensive documentation and reporting of processes, automation strategies, and metrics for executive leadership. + Proactively identify risks, bottlenecks, and areas for improvement, driving remediation and optimization efforts. + Maintain up-to-date knowledge of emerging technologies, industry trends, and regulatory requirements relevant to healthcare and AEP operations. **Use your skills to make an impact** **Required Qualifications:** + 7+ years of experience in technology leadership roles, with demonstrated success supporting large-scale, time-sensitive programs (preferably in healthcare or regulated industries). + Deep expertise in DevOps, CI/CD, and process automation within complex enterprise environments. + Proven experience implementing and optimizing DevOps governance standards, automation pipelines, and compliance controls (e.g., pipeline templates, automated rollbacks, metrics and KPI tracking, and security integration). + Strong project management, analytical, and problem-solving skills. + Excellent interpersonal and communication skills with the ability to influence stakeholders at all levels. **Preferred Qualifications:** + Bachelor's degree in Computer Science, Information Technology, Engineering, or related field; Master's degree preferred. + Experience with AEP or similar annual readiness events in the healthcare insurance industry. + Familiarity with Humana's DevOps platforms, governance standards, and automation frameworks. + Certifications in DevOps, Cloud Architecture, or Process Automation (e.g., AWS, Azure, Google Cloud, PMP). **Why Humana:** At Humana, we invest in our people and technology to deliver transformative solutions that improve the lives of our members and communities. Join us to help shape the future of healthcare technology. **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. $97,900 - $133,500 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-11-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$97.9k-133.5k yearly 27d ago
Staff Utilization Management Clinical Pharmacist
Humana 4.8
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. $104,000 - $143,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-15-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. 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 ***************************************************************************
$37k-57k yearly est. Easy Apply 3d ago
Provider Contracting Network Rep
Humana 4.8
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. Provider Contracting Professional 2 + Actively communicates contract terms, payment structures, reimbursement rates to providers internal and external constituents + Negotiating and maintaining contracts with hospital partners to ensure our network meets regulatory and business requirements. + Managing relationships with key providers to support member access, minimize disruption, and maintain competitive advantage. + Ensuring contract terms are implemented accurately and that our organization is protected from risk, both financially and legally. + Supporting cross-functional teams with timely updates on contracting status, rate changes, and network developments. + Managing these contract relationships with large statewide hospital systems requires the team to work with internal and external constituents on all areas of contracting; network management; adequacy and gaps; provider education; conflict resolution; claim escalation and research; compliance initiatives and grievances; joint operating committees; and all other facets of the business while also working closely with our Humana counterparts on enterprise initiatives. **Use your skills to make an impact** **Required Qualifications** + 2 or more years of experience in negotiating managed care contracts with physician specialty, hospital and/or other provider contracts. + Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers. + Experience with public speaking and presentation skills **Preferred Qualifications** + Bachelor's degree + Experience with ACO/Risk Contracting + Experience with Value Based Contracting + Excellent written and verbal communication skills + Ability to manage multiple priorities in a fast-paced environment + Proficiency in MS Office applications **Additional Information** + Travel to Provider facing meetings as needed based on business needs + Hours- 8am to 5pm EST As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. **Work at Home Guidance** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested + Satellite, cellular and microwave connection can be used only if approved by leadership + Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker. \#LI-BB1 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $65,000 - $88,600 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-14-2026 **About us** About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As a wholly owned subsidiary of Humana, CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties. About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$65k-88.6k yearly 3d ago
Encounter Data Management Lead
Humana 4.8
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: 05-07-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$94.9k-130.5k yearly 48d ago
Medical Director - Post-Acute Care Management - Care Transitions - Remote anywhere in US
Unitedhealth Group 4.6
Cleveland, OH jobs
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** **Why Care Transitions?** At Care Transitions, our mission is to work with extraordinarily talented people who are committed to making a positive and powerful impact on society by transforming health care. Care Transitions is the result of almost two decades of dedicated visionary leaders and innovative organizations challenging the status quo for care transition solutions. We do health care differently and we are changing health care one patient at a time. Moreover, have a genuine passion and energy to grow within an aggressive and fun environment, using the latest technologies in alignment with the company's technical vision and strategy. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. We are currently looking for Medical Directors that can work daytime in any of the continental time zones in the US. **Primary Responsibilities:** + Provide daily utilization oversight and external communication with network physicians and hospitals + Daily UM reviews - authorizations and denial reviews + Conduct peer to peer conversations for the clinical case reviews, as needed + Conduct provider telephonic review and discussion and share tools, information, and guidelines as they relate to cost-effective healthcare delivery and quality of care + Communicate effectively with network and non-network providers to ensure the successful administering of Care Transitions' services + Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers + Represent Care Transitions on appropriate external levels identifying, engaging and establishing/maintaining relationships with other thought leaders + Collaborate with Client Services Team to ensure a coordinated approach to delivery system providers + Contribute to the development of action plans and programs to implement strategic initiatives and tactics to address areas of concern and monitor progress toward goals + Interact, communicate, and collaborate with network and community physicians, hospital leaders and other vendors regarding care and services for enrollees + Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting + Regularly meet with Care Transitions' leadership to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues + Provide input on local needs for Analytics Team and Client Services Team to better enhance Care Transitions' products and services + Ensure appropriate management/resolution of local queries regarding patient case management either by responding directly or routing these inquiries to the appropriate SME + Participate on the Medical Advisory Board + Providing intermittent, scheduled weekend and evening coverage + Perform other duties and responsibilities as required, assigned, or requested You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Board certification as an MD, DO, MBBS with a current unrestricted license to practice and willing to maintain necessary credentials to retain the position + Current, unrestricted medical license and the ability to obtain licensure in multiple states + 3+ years of post-residency patient care, preferably in inpatient or post-acute setting **Preferred Qualifications:** + Licensure in multiple states + Willing to obtain additional state licenses, with Optum's support + Understanding of population-based medicine, preferably with knowledge of CMS criteria for post-acute care + Demonstrated ability to work within a team environment while completing multiple tasks simultaneously + Demonstrated ability to complete assignments with reasonable oversight, direction, and supervision + Demonstrated ability to positively interact with other clinicians, management, and all levels of medical and non-medical professionals + Demonstrated competence in use of electronic health records as well as associated technology and applications + Proven excellent organizational, analytical, verbal and written communication skills + Proven solid interpersonal skills with ability to communicate and build positive relationships with colleagues + Proven highest level of ethics and integrity + Proven highly motivated, flexible and adaptable to working in a fast-paced, dynamic environment *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Compensation for this specialty generally ranges from $238,000 to $357,500. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$238k-357.5k yearly 49d ago
RN Clinical Care Coordinator - Franklin County, OH
Unitedhealth Group 4.6
Columbus, OH jobs
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start **Caring. Connecting. Growing together** The RN Clinical Care Coordinator will be the primary care manager for a panel of members with complex medical/behavioral needs. Care coordination activities will focus on supporting members' medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care. This is a home-office based position with field responsibilities. You will spend approximately 50% to 75% of the time in the field within an assigned coverage area. Candidates must be in Franklin County, OH and willing to commute to surrounding counties. If you reside in Franklin County, OH or surrounding counties, you will have the flexibility to work remotely* as you take on some tough challenges. **Primary Responsibilities:** + Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs + Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines + Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan + Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health + Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission + Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Current, unrestricted independent licensure as a Registered Nurse in Ohio + 2+ years of clinical experience as an RN + 1+ years of experience with MS Office, including Word, Excel, and Outlook + Reliable transportation and the ability to travel up to 75% within Franklin County, OH and surrounding counties in OH to meet with members and providers + Reside in Franklin County, OH and surrounding counties **Preferred Qualifications:** + BSN, Master's Degree or Higher in Clinical Field + CCM certification + 1+ years of community case management experience coordinating care for individuals with complex needs + Experience working in team-based care + Background in Managed Care *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. #UHCPJ _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$28.3-50.5 hourly 54d ago
Policy Governance Professional 2
Humana 4.8
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Policy Governance Professional 2 policy Governance is the combination of Compliance processes established and executed that are reflected in the organization's structure and how it is managed and led toward achieving goals. The Policy Governance Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Policy Governance Professional 2 supports the ongoing development, review, and management of Utilization Management (UM) policies and procedures. This role works closely with UM governance and relevant committees, ensuring documentation and reporting align with regulatory standards and organizational objectives. The position also assists with monitoring and reporting quality metrics, and is responsible for preparing clear, accurate written materials to support compliance and continuous improvement initiatives. Responsibilities: + Assist with the development, review, and maintenance of UM policy and procedure documentation, ensuring compliance with regulatory requirements and enterprise standards. + Support UM governance activities and provide committee support by preparing meeting materials, documenting meeting minutes, and tracking action items. + Collect, analyze, and report on UM quality metrics to inform decision-making and support continuous improvement efforts. + Prepare clear, concise, and accurate written communications, summaries, and reports related to UM governance, quality metrics, and policy activities. + Facilitate communication and training related to UM policy requirements, reporting resources, and compliance protocols. + Assist with the escalation and documentation of suspected policy violations in accordance with established Humana procedures **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree + Less than 5 years of technical experience + Experience with UM operations, policy governance, committee support, and/or quality reporting in a healthcare environment. + Strong written communication and documentation skills. + Familiarity with regulatory standards (e.g., HIPAA, HITRUST, NIST) and compliance practices. + Must be passionate about contributing to an organization focused on continuously improving consumer experiences **Preferred Qualifications** + Graduate or advanced degree + Background in policy or compliance **Additional Information** **WAH Internet Statement** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is 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. **Benefits** 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 **HireVue** As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. **SSN Alert** Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $65,000 - $88,600 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-14-2026 **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************
$65k-88.6k yearly Easy Apply 5d ago
Associate Director, IT Project Management
Humana 4.8
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Associate Director, IT PMO is accountable for the overall effectiveness, maturity, and delivery outcomes of the Cybersecurity segment in the IT Project Management Office. This role provides strategic leadership for program and project delivery, leads PMO managers and senior practitioners, and supports establishing the operating model, standards, and rhythms that enable predictable, high‑quality execution of complex initiatives. The Associate Director partners closely with Portfolio Management, Finance, Cybersecurity, and Business Leadership to ensure approved initiatives are delivered successfully, interdependencies are actively managed, and delivery performance is transparent and aligned with enterprise objectives. The p[erson in this role will have experience in security frameworks and regulatory compliance. This role does not own portfolio governance or demand decision‑making but is responsible for execution excellence once initiatives are approved. **Key Competencies** + Enterprise program & project management leadership + PMO strategy, operating model, and maturity development + Executive communication & stakeholder influence + People leadership and leadership‑of‑leaders + Cross‑organizational dependency and risk management + Financial and delivery performance management (in partnership) + Change leadership and organizational enablement **Key Responsibilities** **PMO Strategy & Operating Model** + Contribute to the PMO vision, strategy, and operating model to support enterprise delivery needs. + Implement standardized program and project delivery practices, tools, and operating rhythms across assigned segments. + Drive continuous improvement in delivery predictability, transparency, and value realization. + Ensure PMO practices scale appropriately across diverse technologies and delivery models (Agile, Hybrid, Waterfall). **Leadership & Talent Development** + Lead and develop PMO managers, program managers, project managers, and related delivery roles. + Establish clear accountability, performance expectations, and career pathways across the assigned PMO segments. + Build leadership capability within the PMO through mentoring, coaching, and succession planning. + Foster a culture of accountability, transparency, collaboration, and continuous learning. **Program & Project Delivery Oversight** + Provide executive oversight of complex programs and critical initiatives spanning multiple workstreams and teams. + Ensure effective management of interdependencies, risks, issues, milestones, and delivery outcomes. + Hold PMO leadership accountable for delivery performance, recovery actions, and risk mitigation. + Serve as the escalation point for enterprise level delivery challenges and cross organizational conflicts. + Ensure consistent application of program and project management methodologies, standards, and templates. + Act as the escalation point for delivery risks, blockers, and complex interdependencies. **Resource & Capacity Management** + Lead PMO resource planning and capacity management for assigned segments. + Partner with portfolio leaders, and functional managers to align resources with approved initiatives. + Assign practitioners based on capability, workload, and development needs. **Portfolio Management** + Partner with finance and portfolio managers to support management of portfolio budgets and forecasts. + Deliver executive-level reporting on portfolio health, status, KPIs, and strategic alignment. + Facilitate portfolio delivery meetings, steering committees, and executive reviews. **Stakeholder & Executive Partnership** + Act as a trusted advisor to executives on portfolio delivery health, enterprise risks, and execution readiness. + Partner with Portfolio Management, Finance, and Business Leadership to support execution of approved initiatives. + Navigate complex stakeholder environments and resolve competing priorities affecting delivery. **Reporting, Metrics & Transparency** + Define and oversee KPIs that measure delivery performance, program health, and PMO effectiveness. + Ensure consistent, high‑quality executive reporting across programs and projects. + Identify systemic risks, delivery trends, and opportunities for improvement across the enterprise. **Use your skills to make an impact** **Required Qualifications** + 10 + years of progressive program and project management experience leading large-scale complex technical initiatives. + 5+ years of people leadership experience, including managing managers and senior practitioners. + 5+ years of managing large-scale cybersecurity initiatives, with familiarity in security frameworks (e.g., NIST, CIS) and regulatory compliance (HIPAA, PCI, SOC2) + Bachelor's degree in information technology, computer science, or related field + Demonstrated success leading large‑scale, multi‑year programs with significant cross‑organizational dependencies. + Strong understanding of project and program management methodologies (Agile, Hybrid, Waterfall). + Exceptional executive communication, leadership presence, and stakeholder management skills. **Preferred Qualifications** + Master's degree in Business Administration or related field. + PMP, PgMP, PMI-ACP, SAFe, Six Sigma, cybersecurity certifications. + Experience with financial oversight and strategic initiative planning + Experience leading PMOs within large enterprise or highly regulated environments. + Knowledge of project management tools (ServiceNow, Jira, ADO, Office Suite of Products, etc...) + Experience in highly regulated industries (healthcare, finance, government). + Familiarity with cybersecurity tools and platforms (e.g., identity management, endpoint security, data protection) **Additonal Information** Location Preference - IT hub locations: Louisville, KY; Tampa, FL; Dallas, TX; Boston, MA; New York City; or Washington, D.C. 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. $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: 01-25-2026 **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 ***************************************************************************
$138.9k-191k yearly 4d ago
Senior Application Architect
Humana 4.8
Columbus, OH jobs
**Become a part of our caring community and help us put health first** The Senior Application Architect at Humana designs and develops IT architecture solutions that address complex business challenges, ensuring alignment with Humana's enterprise technology standards. This role delivers application modernization, secure automation, and the adoption of reusable architectures. The architect collaborates with enterprise teams to advance security, operational excellence, and cost beneficial solutions across the organization. We are hiring an Application Architect to support solution design and delivery specifically for Humana's corporate Legal technology demands. You will partner with the Lead Application Architect to design modern, secure, scalable applications and guide engineering teams through implementation. **Key Responsibilities** - Design end-to-end application architectures (UI, API, data, integrations, security). - Create architecture diagrams, design docs, and reusable patterns for cloud, SaaS, AI, and legacy modernization. - Provide technical leadership to development teams; conduct design and code reviews. - Ensure all solutions follow enterprise standards for security, scalability, and resiliency. - Support projects across the SDLC and collaborate with DevOps, Security, Cloud, and Data teams. - Participate in POCs and technology evaluations. - Coordinate issue resolution with production support team(s). **Why Join** - Work closely with the Lead Application Architect on high-impact, cross-functional projects; substantial exposure to AI development and other innovative automation **Use your skills to make an impact** **Required Qualifications** - 6+ years in application development, 2+ years in architecture or technical design. - Strong experience with modern stacks (React/Angular, .NET/Java/Python/Node). - Knowledge of Azure cloud services, containers, APIs, and CI/CD. - Understanding of IAM (Azure AD) and secret management (HashiCorp Vault). - Strong communication and documentation skills. **Preferred Skills** - Experience with AI/ML-enabled apps, RAG, or automation platforms. - Experience with cloud migrations, legacy modernization, and event-driven architectures. - Exposure to enterprise domains like Compliance, HR, Finance, Legal, or Risk. **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. $106,900 - $147,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-13-2026 **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 ***************************************************************************
$106.9k-147k yearly 28d ago
Physician Resident- Pathways| Unity Health Network
Unitedhealth Group Inc. 4.6
Akron, OH jobs
Physician Pathways: Prepare for Day One at your practice up to one year in advance of completing your resident of fellowship program. As a Pathways Physician, you'll receive a salary, mentoring, and various other learning experiences focused on preparing for your career with the Optum American Health Network with minimal impact on your Resident training time. Interested in learning more about Value Based Care before day one? Getting to know your peers? Ease the stress of your transition to physician provider with an unparalleled head start "virtually" Optum American Health Network Primary Care Physicians -- Ohio Pathways For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. As a part of the Optum network, American Health Network is seeking career-minded Family Medicine or Internal Medicine residents who want to jump start their clinical career. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Position Highlights: * Receive a generous guaranteed salary in your final year of training * Enhance the experience of your final months of training and eliminate the burden of job searching; employment is guaranteed at the completion of your residency * Learn how to practice and thrive in a value-based care model * Gain exposure to the Quadruple Aim framework and various understandings of care settings * Receive mentorship from experienced physicians within your future practice, easing your transition from training into practice * The customized program will be completed at American Health Network facilities in Indiana, or Ohio, and virtually * The program requires a commitment of only a few hours per month What makes Optum different? * Providers are supported to practice at the peak for their license * As one of the most dynamic and progressive health care organizations in the country, Optum consistently delivers clinical outcomes that meet or exceed national standards * We promote a culture of clinical innovation and transformation * We are a top performer nationally of the Quadruple Aim initiative * We are influencing change on a national scale while still maintaining the culture and community or our local organizations You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Key Takeaways: * Optum fosters a collaborative culture focused on growth, innovation and mutually uplifting one another, enabling deep physician satisfaction * Tailored development programs like Physician Pathways smooth the transition from training to practice with expert mentorship * Physicians praise the supportive environment facilitating work-life balance, strong patient connections, and the ability to push care delivery boundaries Required Qualifications: * M.D. or D.O. * Must be transitioning into your final year of residency or fellowship Preferred Qualification: * Preferred candidate will be a local physician resident in Ohio--open to other areas as well Would you thrive with Optum? * Do you strive to practice evidence-based medicine? * Are you seeking a practice focused on patient-centered quality care, not volume? * Are you a team player - comfortable delegating and empowering teams? * Are you constantly seeking better ways to do things? * Do you want to be part of something better? About Optum: At Optum, we've found that putting clinicians at the center of care is the best way to improve lives. Our physician-led organization is one of the most dynamic and progressive health care organizations in the world, serving almost 130 million people through more than 78,000 aligned physicians and advanced practice clinicians. You will find our team working in local clinics, surgery centers and urgent care centers, within care models focused on managing risk, higher quality outcomes and driving change through collaboration and innovation. Learn more at ************************************ * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
$49k-167k yearly est. 3d ago
Compliance Professional
Humana 4.8
Columbus, OH jobs
**Become a part of our caring community and help us put health first** Humana Healthy Horizons is hiring a Compliance Professional who will support efforts for overall Medicaid business by joining the team overseeing the facilitation of Policy Governance. The Policy Governance team coordinates ad hoc as well as annual updates to all Medicaid policies across business units and across states. This core function is crucial to Humana ensuring that all Medicaid policies are accurate, up-to-date and reviewed annually, at a minimum. This is a fully remote, work from home position. The Policy Governance Compliance Professional works to ensure accurate and updated policy content for Medicaid. The Compliance Professional will work collaboratively with business partners to facilitate policy updates throughout the year as well as during annual review. This position requires strong technical skills to leverage the designated system for policy maintenance, as well as strong relationship skills in working collaboratively with business partners. **Key responsibilities for this role include:** + Effectively working with business partners from all levels and all business areas throughout Humana. + Performing ad hoc and annual updates to policies and ensuring assigned state-specific reporting is completed timely and accurately. + Becoming an expert in using the designated system for ad hoc and annual policy updates, so to be able to perform trainings for business partners on use of the system and answer business partner questions. + Approaching Policy Governance with a lens of process improvement of how the team can continue driving efficiency and standardization in policies and procedures. + Assisting with drafting and sending policy-related communications to business partners. + Escalating to management any policy-related questions or situations, as necessary. + Other related activities, as assigned by management. **Use your skills to make an impact** **Required Qualifications** + Bachelor's Degree or equivalent work experience. + 2+ years of project management experience. + 2+ years of proven experience in an audit, compliance, or regulatory role in a managed care environment. + Medicaid experience. + Strong written and verbal communication skills; able to effectively communicate in a clear manner. + Demonstrated organizational skills, ability to simultaneously work on multiple projects at once, and ability to ensure deliverables are timely and accurate. + Demonstrated ability in building and maintaining positive cross-functional relationships and facilitating and consulting across teams. **Preferred Qualifications** + Advanced or graduate degree. + Policy management experience. + Certification such as a Certified Public Accountant, Certified Information Systems Auditor, or Certified Internal Auditor, Project Management certification, Healthcare Compliance Certification, etc. + Medicaid health care insurance compliance/regulatory experience. + Solid understanding of Humana's operations, technology, communications, processes and interconnectivity between them. + Experience interpreting Medicaid contracts. + Residing in the Eastern or Central time zones preferred. **Work at Home Requirements** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is required. + 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. **Additional information** + **Workstyle:** Remote, work at home. + **Core workdays and hours:** Monday through Friday, 8:00 am-5:00 pm in the Eastern Standard Time (EST) regardless of where you reside. **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. **Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be** asked to provide a social security number, if it is not already on file. When required, an email will be sent from ******************** with instructions to add the information into the application at 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. $65,000 - $88,600 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. Application Deadline: 01-12-2026 **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 ***************************************************************************
$65k-88.6k yearly Easy Apply 6d ago

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