Humana

Become a part of our caring community and help us put health first The Director, Provider Contracting, leads and manages the provider networks for all of Humana’s various lines of business through the NC Contracting team. The Director also initiates, analyzes, and negotiates hospital, physician, and/or other provider contracts and agreements for the organization; including value-based arrangements directly with provider groups and integrated systems. The Director, Provider Contracting requires an in-depth understanding of contracting, reimbursement methodology, and financial acumen. The role requires close collaboration with various internal departments and leaders to obtain consensus and ensure the successful execution of contracts and continued provider relationships. The position coordinates the contracting functions with other key Humana areas such as Provider Engagement, Network Operations for contract loads, National Contracting, and other functional leaders across the organization. Lead, mentor, and manage a team of contracting professional, fostering a collaborative and high-performance work environment. Develop and execute strategic plans for contracting with hospital, physician, ancillary, and valued-based providers. Negotiate contract terms, pricing, and conditions with healthcare providers to secure favorable agreements. Ensure all contracts comply with company policies, regulatory requirements, and industry standards. Collaborate with internal leaders across departments to obtain necessary approvals and align contracting strategies with organizational goals. Monitor and evaluate the performance of contracted providers, ensuring high quality care and service delivery. Maintain comprehensive documentation and records of all contracts and negotiations. Stay informed about industry trends, regulatory changes, and competitive landscape to inform contracting strategies. Address and resolve any issues or disputes related to contracts in a timely and effective manner. Provide regular reports and updates to senior management on contracting activities, performance, and outcomes. Other duties as assigned by senior leadership. Use your skills to make an impact Required Qualifications Bachelor's Degree5+ years of successfully negotiating and managing contracts with hospitals, physicians, and ancillary providers.3+ years of leadership and team management skills, with the ability to motivate and develop staff.Contract preparation, negotiation, and execution skills, with an in-depth knowledge of Medicare and other reimbursement methodologiesValue based contracting experienceStrong financial acumen with proficiency in analyzing and interpreting financial trends in the provider contracting arenaExcellent communication and interpersonal skills, with the ability to collaborate effectively with internal and external stakeholders.Strategic thinker with strong analytical and problem-solving abilities.Ability to manage multiple priorities and meet deadlines in a fast-paced environment.Proven track record of accomplishing targets and goalsAbility and willingness to travel within the region, as required Preferred Qualifications Master's or J.D. DegreeExperience with ACO/Risk Contracting​ Additional Information This position is considered "remote/work at home", however you must be within commutable distance from North Carolina providers. Work at Home Information To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggestedSatellite, cellular and microwave connection can be used only if approved by leadershipEmployees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information #LI-Remote #LI-JR1 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. $136,200 - $187,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. 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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized. All work occurs within a context of regulatory compliance, and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work. The Medical Director’s work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient or post-acute care environments. Has discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management. Medical Directors support Humana values, and Humana’s Bold Goal mission, throughout all activities. Responsibilities The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts. The ideal candidate supports and collaborates with other team members, other departments, Humana colleagues and the Regional VP Health Services. After completion of structured and mentored training, daily work is performed with minimal direction, but with ready support from other team members. Enjoys working in a structured environment with expectations for consistency in thinking and authorship. Exercises independence in meeting departmental expectations, and meets compliance timelines. Use your skills to make an impact Required Qualifications. MD or DO degree5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).Board Certified in an approved ABMS Medical Specialty with continued certification throughout employment.A current and unrestricted license in at least one jurisdiction and willing to obtain additional license(s), if required.No current sanction from Federal or State Governmental organizations, and able to pass credentialing requirements.Excellent verbal and written communication skills.Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services (such as inpatient rehabilitation). Preferred Qualifications Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance.Experience with national guidelines such as MCG® or InterQualInternal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine clinical specializationAdvanced degree such as an MBA, MHA, or MPHExposure to Public Health principles, Population Health, analytics, and use of business metrics.Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health.The curiosity to learn, the flexibility to adapt and the courage to innovate Additional Information Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field. Typically reports to a Regional Vice President of Health Services, Lead, or Corporate Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team for several months after training, until positions become available for specific markets. May participate on project teams or organizational committees. 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 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. $199,400 - $274,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. 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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Become a part of our caring community and help us put health first The Clinical Vendor Oversight Senior Informaticist supports the development and implementation of reporting and metrics that influence providers, members, market partners, and utilization management vendors. The work will require the ability to integrate data from multiple sources to produce the requested/required data elements needed for vendor reporting and analysis. Supports routine vendor metrics and dashboard reviews to help identify potential process gaps and performance trends. Applies disciplined analytics to optimize vendor programs to maximize revenue growth. Coordinates with other analytics, IT, and business areas across the organization to ensure work is completed with insights from knowledge SMEs. Work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Clinical Vendor Oversight Senior Informaticist leverages advanced knowledge of data, modeling, optimization, and tools. Applies disciplined analytics to predict behavior and optimize programs and products to maximize revenue growth. Utilizes advanced or predictive modeling to develop, test and validate cases that improve the outcomes and quality of the programs we offer. Contributes to more innovative approaches to financial models, while building knowledge of the business. Understands and analyzes complex data, articulates to various units within the company at the appropriate level, impacts the business from mathematical concepts which have a potentially sizeable dollar impact on the business. 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. In this role you will: Develop and establish strong and effective working relationships with Clinical Vendor Management Professionals, leadership, and external clinical vendors who aid in managing medical utilization for Medicare, Medicaid, and Commercial lines of business.Master the intricacies of the data fieldsObtain, validate, and analyze data from internal and external raw sources and finished reports, anticipating the needs of report end usersSupport the design, development, maintenance, and delivery of operational reports, dashboards, and ad hoc requestsContinually identify ways to improve and enhance current reports, increasing value and usabilityCollect and document business requirements for reporting and analysis initiatives.Support research necessary to fully understand and correctly utilize the required clinical dataAid in deriving observations and insights from metrics to support and improve clinical operations Use your skills to make an impact Required Qualifications Bachelor's degree and 5+ years of data analytics experience OR Master's degree and 3 years of experience3+ years of experience with data mining, trend identification, and using data to drive business outcomes, recommendations, actionable insights, and decisionsExperience with data management and analytics tools such as SQL, SAS, or Azure Synapse AnalyticsExperience with business intelligence and visualization tools such as Power BI or Tableau and ExcelDemonstrated ability in verbal and written communication to articulate and present data findings and insights to all levels, including senior leadershipStrong attention to detailMust be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications Experience applying Lean and Six Sigma principles and methodologies to drive process efficiency and qualityExperience using automation tools, like MS Power Automate, to create process efficienciesExperience with predictive modelingExperience with healthcare authorization data and claims data, and interoperability standards like FHIRExperience mapping disparate sources of data, and creating relational data models and databases 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. $86,600 - $119,200 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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Become a part of our caring community and help us put health first The Process Improvement Lead analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable, and quantifiable business process improvements, leads projects and facilities coordination and communication between owners and teams responsible for execution. The Process Improvement Lead works on problems of diverse scope and complexity ranging from moderate to substantial, influencing outcomes. The Process Improvement Lead supports operational health plan functions and researches best business practices, owns project planning and facilitates coordination and communication between owners and other teams responsible for execution and production. Collects and analyzing process data to initiate, develop and recommend business practices and procedures which focus on enhanced service delivery and increased productivity.Works with cross functional teams across the Enterprise Operations, including Member and Provider Call Center, Claims, Provider Support areas and Compliance etc.Supports the development, prioritization, and execution of re-engineering business processes and leads performance improvement projects.Communicates responsibilities, assignments, and tracks deliverables to teams, and at key points throughout projects. Possesses good planning skills and the ability to anticipate problems and develop a plan of action to prevent delays in projects and/or the department’s workflow Leads meetings with stakeholders to ensure accountability and timely delivery of Market Operations and LDH deliverablesServes as an essential member of the Market Operations team leading multiple projects of varying levels of complexity. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision,Uses independent judgment requiring analysis of variable factors and determining the best course of action.Other duties as assigned. Use your skills to make an impact Required Qualifications Bachelor's degree2+ years of project leadership experience guiding teams through change management as a team leader, Subject Matter Expert, SME3+ years of experience in project facilitation and/or process improvement.Intermediate to advanced proficiency in various MS programs specifically, Excel, Word, PowerPoint & Visio.Ability to build and maintain effective working relationships, exhibiting a high level of influence.Strong, demonstrated organizational and interpersonal skills; able to interact effectively with people at all levels within a team or internalExcellent organizational skills and able to manage multiple priorities; comfortable working in a highly visible, fast-paced environment. Preferred Qualifications: Experience in Medicaid operations processesAdvanced Excel skills (Pivot Tables) Previous experience working in a managed care field. Work at Home Criteria  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.   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.  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. $93,000 - $128,000 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us 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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Become a part of our caring community and help us put health first The Care Management Support Assistant 2 contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Management Support Assistant 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. The Care Management Support Assistant 2 Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works under minimal direction. Follows standard policies/practices that allow for some opportunity for interpretation/deviation and/or independent discretion. Use your skills to make an impact Required Qualifications 3 years of technical experience in the administration or healthcare fieldThis position is remote, but candidate must reside in FloridaStrong knowledge and experience using Microsoft programs to include Word, Excel, and OutlookFamiliarity with care and well-being resources within FL Preferred Qualifications Associate's DegreeCall center or customer service experience Additional Information 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 #LI-Remote 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. $34,500 - $47,400 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Become a part of our caring community and help us put health first The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Creating Healthy Communities is good for the Soul. Join Us! The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatmentCoordinates and communicates with providers, members, or other parties to facilitate appropriate discharge planning including to assist with social determinants and closing gapsUnderstands 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 neededFollows established guidelines/procedures Use your skills to make an impact Required Qualifications Licensed Registered Nurse (RN) Compact license required, with no disciplinary actionAt least 3 years of varied clinical nursing experienceUtilization management experience which includes following MCG/Milliman or Interqual guidelinesPrior clinical experience preferably in an acute care, hospital, skilled or rehabilitation clinical settingComprehensive knowledge of Microsoft Word, Outlook and ExcelAbility to work independently under general instructions and with a teamMust be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications Bachelor's degree in nursing (BSN)CCM CertificationHealth Plan experiencePrevious Medicare/Medicaid ExperienceCall center or triage 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 suggestedSatellite, cellular and microwave connection can be used only if approved by leadershipAssociates 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 expenseHumana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/jobWork from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Additional Information Hours are: Monday-Friday 8am-5pm CST, overtime or weekend work may be required based on a business needThis is a remote position 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. $69,800 - $96,200 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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Become a part of our caring community and help us put health first The Compliance Audit Nurse is responsible for auditing care management activities and documentation to ensure adherence to policies, procedures, and regulations. The Compliance Audit Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Compliance Audit Nurse ensures mandatory reporting completed. Conducts and summarizes compliance audits. Collects and analyzes data daily, weekly, monthly or as needed to assess outcome and operational metrics for the team and individuals. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Use your skills to make an impact Required Qualifications Bachelor's degree in NursingActive Registered Nurse, RN, license in the state of Oklahoma with no discrepancies3+ years clinical nursing experience1+ years Prior Compliance Auditing experience in healthcareProficient with Microsoft Office products including Word, Excel and OutlookAbility to work independently under general instructions and with a teamMust reside in the state of Oklahoma Preferred Qualifications Previous Medicare/Medicaid experience a plusPrevious experience in utilization management, case management, discharge planning and/or home health or rehabCertification in Case Management a plus (CCM) Additional Information Workstyle – Remote work at Home with the ability to travel to the office for meetings and trainings as needed.​ Work at Home Criteria  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.   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.  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. $69,800 - $96,200 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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Become a part of our caring community and help us put health first Humana/iCare is seeking a Long Term Care Functional Screener to join the growing Milwaukee County team in the Family Care Partnership (FCP) program. The Functional Screener is responsible for completing the Long Term Care Functional Screen (LTCFS) for iCare’s Family Care Partnership members, as required and outlined in the Wisconsin LTCFS Instructions. Share your talents and develop your skills all while doing your part to improve the lives of others. Essential Duties and Responsibilities: Coordinate appointments with members or legal representative to complete Annual and Enrollment redetermination of functional eligibility within member’s home; conduct rescreens due to member change in functional abilities for redetermination of eligibility as identified by Interdisciplinary Team (IDT).Utilize established methodology of the Wisconsin LTCFS process to collect member-centered data regarding functional abilities, health status and needs-based use of personal and professional supports and verify consistency of member specific data between functional assessment and member’s record to ensure members functional needs are accurately reflected.Collaborate with the IDT to ensure all assigned LTCFS rescreens are completed within the required time frame. Submit information collected during face-to face interview and collaborative verification into WI State internet-based program while maintaining compliance of state mandated timelines & appropriate professional utilization of LTCFS Instruction Manual. Effectively maintain updates of status to assigned members LTCFS rescreens on department spreadsheets to ensure adherence of State of WI and iCare LTCFS timeframes. Review Level of Care for iCare members including follow-up consultation with Grievance and Appeals or Enrollment/Eligibility/Fiscal staff.Provide appropriate notice of Member Rights, in accordance with contractual requirements, to members who experience a change in level of care that may impact the benefit package or overall program eligibility.Attend meetings and trainings as required to maintain & enhance knowledge of agency processes & the Long Term Care Functional Screen.Maintain LTCFS certification via completion of WI biannual Continuing Skills Test. Use your skills to make an impact Required Qualifications: Bachelor of Arts or Science degree or more advanced degree in a health or human services related field (i.e., social work, rehabilitation, psychology).Minimum of one (1) year experience working with one of the Family Care Partnership Target group population: Frail Elderly, Adults with Developmental/Intellectual, or Physical disabilities, or have a license to practice as a registered nurse in Wisconsin.Knowledge of public long-term care, managed care, & functional eligibility.Available for daytime travel within all FCP iCare service area(s): Milwaukee, Racine, and Kenosha Counties. Long Term Care Functional Screener (LTCFS) Required Qualifications Must be a Certified LTC Functional Screener by the Wisconsin Department of Health Services OR ​​​​​If you are not certified, you must pass the Adult Long-term Care Functional Screen certification modules (80% or higher on each module) within 45 days of hire. Preferred Qualifications: Current WI Adult LTCFS certification Additional Information Workstyle: Field - This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes.Travel: up to 50%. Travel will be primarily throughout Milwaukee, Racine, and Kenosha Counties; May require assisting with coverage in all approved service areas of coverageTypical Work Days/Hours: Monday through Friday; 8:30am – 5:00 pm (CST) Limited Geography Remote - This is a remote position but located within a specific geography. WAH Internet 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. TB 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. Driving This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits. 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 1Paid time off, holidays, volunteer time and jury duty payRecognition pay401(k) retirement savings plan with employer matchTuition assistanceScholarships for eligible dependentsParental and caregiver leaveEmployee charity matching programNetwork Resource Groups (NRGs)Career development opportunities Modern Hire As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. 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 #LI-JP1 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. $47,700 - $65,600 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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Become a part of our caring community and help us put health first The Care Coach 1 assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Coach 1 work assignments are often straightforward and of moderate complexity. We are looking for motivated and dynamic case managers that reside in Broward County, FL This rewarding role allows you to spend time connecting with our members to ensure they receive the services they need. The Care Coach 1 role involves meeting members in their location, spending quality time assessing their needs and barriers and then connecting our members with quality services to promote their ultimate well-being and drive health outcomes. If you enjoy applying your creativity and skills to help those in need find long term solutions, this role is for is for you! Here at Humana we thrive on teamwork and highlighting the success of each of our team members. At Humana one of our main areas of focus is to inspire health in others. We are looking for individuals who enjoy talking to others about their health while providing education, motivation and encouragement. We also desire to cultivate the uniqueness in each of our associates as well as our members and are looking for individuals from various backgrounds who can bring their expertise to the role of the Care Coach 1. If you are looking for a new work family and team of dynamic professionals, we hope you will apply! The Care Coach 1 Visit Medicaid members in their homes, Assisted Living Facilities, and/or Long Term Care Facilities and other care settings – 75-90% local travelAssesses and evaluates member's needs and requirements in order to establish a member specific care planEnsures members are receiving services in the least restrictive setting in order to achieve and/or maintain optimal well-beingPlanning and implementing interventions to meet those needs Coordinating services, and monitoring and evaluating the case management plan against the member's personal goalsGuides members/families towards resources appropriate for their careServices are driven by facilitating interactions with other payer sources, providers, interdisciplinary teams and others involved in the member’s care as appropriate and required by our comprehensive contract Use your skills to make an impact Required Qualifications Care Coaches shall meet one of the following qualifications:Bachelor's Degree with at least 2 years of relevant experience (Health Services, Social Work, Psychology)Registered Nurse (RN), licensed in the state of Florida with at least 2 years of relevant experience.Licensed Practical Nurse (LPN), licensed in the state of Florida, with at least 4 years of relevant experienceA minimum of 6 years of Health Services/Case Management Experience Prior experience with Medicare & Medicaid recipientsIntermediate to advanced computer skills and experience with Microsoft Word, Excel and OutlookAHCA Fingerprint Required.This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.Ability to work Monday-Friday 8:30am-5:00pm Preferred Qualifications Bilingual English/Spanish with ability to pass a Language Proficiency ExamPrior nursing home diversion or long term care case management experienceExperience with electronic case note documentation and documenting in multiple computer applications/systemsExperience working with geriatric populationExperience with health promotion, coaching and wellnessKnowledge of community health and social service agencies and additional community resources701B CertificationMedication application (RFA) experience #LPN #LicensedPracticalNurse #CaseManager #SocialWorker #Psychology #Bilingual 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. $47,700 - $65,600 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Become a part of our caring community and help us put health first Come join our IT Strategy team! We design and activate strategies to address healthcare opportunities and challenges with technology-enabled solutions. As a Principal in our team you’ll enable Humana leaders as they leverage modern technology to deliver health care and insurance for patients and members. Our team operates at the evolving and mission-driven intersection of strategy, technology, and healthcare. This role offers you the chance to help lead and grow as we transform the information technology of healthcare. Primary responsibilities Create a clear strategy for IT, and harmonize that IT strategy with enterprise and business strategy in a dynamic, fast-paced environmentDeliver executive-level presentations that frame data-based challenges, opportunities, and the strategic roadmaps to deliver outcomesActivate IT strategies by engaging business and tech leaders, handing off execution to operational teams, and driving follow-ups when appropriateCoach direct team members in our IT Strategy team and indirect team members through our many enterprise partnershipsInspire others to embrace and advance IT’s strategy through occasional teaching and coaching sessions that help Humana associates understand and enable IT strategyFamiliarize yourself with emerging ideas and technologies, including disruptive ones Use your skills to make an impact Required qualifications Bachelor's degreeProgressive experience with a top management consulting firm6-10 years of corporate, business, and/or IT strategy experience working with executives, senior leaders, and subject-matter expertsPassionate about continuously improving consumer and stakeholder experiencesSkilled in strategy tools like presentations, documents, and data spreadsheetsReadiness to work mostly East Coast hours Preferred qualifications Technology and/or digital transformation experienceHealth insurance, provider, and/or integrated health care experienceExperience working with/in large organizationsBusiness analytics and/or financial experienceMaster’s or other post-secondary degree 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. $136,200 - $187,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. 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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Become a part of our caring community and help us put health first The Provider Contracting Coordinator initiates physician and/or other provider contracts and agreements. The Provider Contracting Coordinator performs advanced administrative/operational/customer support duties that require independent initiative and judgment. The Provider Contracting Coordinator manages provider network reporting and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge. Use your skills to make an impact Required Qualifications 1 year of provider relations, provider contracting or account management experience Excellent written and oral communication skills Ability to manage multiple priorities in a fast-paced environment Proficiency in Microsoft Excel (manage large volumes of data through tools such as pivot table & V-lookup) Preferred Qualifications Bachelor's Degree Experience with Behavioral Health specialties Additional Information This role is considered "remote/work at home" and can be based anywhere in the United States. Work at Home Information To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggestedSatellite, cellular and microwave connection can be used only if approved by leadershipEmployees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information #LI-Remote #LI-JR1 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. $37,200 - $51,200 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. 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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Become a part of our caring community and help us put health first Humana Healthy Horizons is seeking a Provider Contracting Professional who initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements related to Medicaid health plans. The Provider Contracting Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Provider Contracting Professional responsibilities include (but not limited to): Communicates contract terms, payment structures, and reimbursement rates to providers. Analyzes financial impact of contracts and terms. Maintains contracts and documentation within a tracking system. Understands Medicaid contracting, to include Long-Term Service Support (LTSS) and Home Care Based Services (HCBS) contracting requirements. May assist with identifying and recruiting providers based on network composition and needs. 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. Use your skills to make an impact Required Qualifications 2+ years of experience in negotiating managed care contracts with physicians, hospitals and/or other provider contracts.Prior successful experience working with Medicaid contracts.Experience with LTSS/HCBS programs and contracts.Proficiency in analyzing, understanding, and communicating financial impact of contract terms, payment structures and reimbursement rates to providers.Excellent written and verbal communication skills.Ability to manage multiple priorities and work independently in a fast-paced environment.Moderate to advanced proficiency working with MS Office applications. 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.Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Preferred Qualifications Bachelor's degree.Experience with ACO/Risk contracting.Experience with Value Based contracting. Additional Information: Workstyle: Remote, work at home.Travel: None.Core Workdays & Hours: Typically, Monday – Friday; typically, 8:00am – 5:00pm Eastern Standard Time (EST). Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more..... Interview Format As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, 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. 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. $63,400 - $87,400 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. 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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Become a part of our caring community and help us put health first The Benefits Administration Professional coordinates the administration of employee benefit programs such as basic and major medical coverage, life, health and disability insurance, pension plans, and other benefits. The Benefits Administration Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Benefits Administration Professional consults with and advises employees on eligibility, provisions, and other matters related to benefits. Maintains benefits records and documents. Prepares employee benefits booklets and other employee benefit communications. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Use your skills to make an impact Required Qualifications 3 years or more of benefit administration experienceMust be able to work in a fast pace environmentCan work independentlyMeet service level agreements in regards to response time back to associate inquiriesProvide great customer serviceExcellent written and verbal communicationStrong Attention to detailAbility to respect the confidentiality nature of human resources workMust be passionate about contributing to an organization focused on continuously improving consumer experiencesAdvanced analytical and problem-solving skillsThis role is located in Louisville, KY and will be hybrid home having mandatory in office days of Tuesday and Wednesday. Preferred Qualifications Bachelor's Degree in Human Resources or Business or related field desiredExcel with V-Lookup experienceDeep understanding of FMLA, ACA and COBRAKnowledge of Human Resource Management software (Workday) or other HCM systemAdvanced analytical and problem-solving skillsBilingual ( English and Spanish) Additional Information Work-At-Home Requirements: To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: • At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested • Satellite, cellular and microwave connection can be used only if approved by leadership • Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. • Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. • Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Interview Format: As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for 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 inviting you to participate in a HireVue interview. In this interview, you will receive a set of interview questions over your phone and you will provide recorded or text message responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded interview will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews. 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. $52,500 - $72,300 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. 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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

Become a part of our caring community and help us put health first The Senior Fraud and Waste Professional conducts investigations of allegations of fraudulent and abusive practices. The Senior Fraud and Waste Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Fraud and Waste Professional 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. 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 WORK STYLE: Work at home/remote with minimal (

Become a part of our caring community and help us put health first Humana Healthy Horizons in Indiana is seeking a Provider Education & Outreach Representative who is responsible for the day-to-day front line relationship management of network providers for Humana’s Healthy Horizons in Indiana, as well as responsible for provider onboarding, training, education, responding to provider inquiries, and resolving issues or complaints. The Provider Education & Outreach Representative will specialize in supporting Long-Term Services and Supports (LTSS) and Home and Community-Based Services (HCBS) providers and/or Physical Health (PH) and Behavioral Health (BH) providers. The Provider Education & Outreach Representatives serve as the primary relationship manager with providers to ensure positive provider experience with Humana Healthy Horizons and promote network retention. Key roles and responsibilities: Meets regularly, both in person and virtually, with assigned providers to conduct trainings and education, including required annual trainings, ensure understanding of Humana policies and procedures, explain Humana systems, etc.Serves as primary relationship manager with LTSS and HCBS providers and/or PH and BH providers to ensure positive provider experience with Humana Healthy Horizons and promote network retention.Supports new assigned providers with onboarding, including orientation session(s).Responds to assigned provider questions or inquires, and if necessary, ensures prompt resolution to provider issues with appropriate enterprise business teams, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate education about participation in Humana’s Indiana Medicaid plan.Convenes Joint Operating Committee meetings with providers, including organizing agendas, materials, and other team members (clinical, provider engagement), to discuss key operational, clinical, and quality related topics. Use your skills to make an impact Required Qualifications Must reside in the state of Indiana.Must be able to travel (up to 50%) in the State of Indiana to provider offices and Humana locations.2+ years of health care or managed care experience working with providers (e.g., provider relations, claims education).Experience working with LTSS and HCBS providers and/or PH and BH providers.Experience working with or in a health care administration setting.Understanding of claims systems, adjudication, submission processes, coding, and/or dispute resolution.Proficiency in analyzing, understanding, and communicating complex issues.Exceptional time management skills and ability to manage multiple priorities in a fast-paced environment.Working knowledge of Microsoft Office applications, such as Word, Excel, Outlook, and PowerPoint.This role is a part of Humana’s Driver Safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.This role is considered patient facing and is a part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. Preferred Qualifications Bachelor’s Degree.Experience with Indiana Medicaid and Medicare Advantage guidelines.Understanding of managed care contracts, including contract language and reimbursement.Comprehensive knowledge of claims systems, adjudication, submission processes, coding, and/or dispute resolution. 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.Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Additional Information: Workstyle: Remote but may vary due to travel and occasional onsite work at the Humana Healthy Horizons office in Indiana.Travel: Up to 50% travel in the state of Indiana to provider offices and Humana locations.Core Workdays & Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST)/Central Standard Time (CST).Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes; 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more..... Interview Format As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, 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. 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. $52,500 - $72,300 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. 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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.