Jobs at Humana

Provides administrative support for utilization management programs within a healthcare or managed-care environment. Reviews and processes information, maintains accurate records, performs data entry, coordinates communications with internal and external stakeholders, and supports care-delivery operations. The role follows established procedures, manages priorities, meets quality and productivity standards, and works under general supervision. Preferred experience includes EMR or case-management systems, medical terminology, healthcare coding, prior authorization, care management, or health-plan operations.

Senior clinical executive leading Utilization Management across Medicare and Medicaid. Sets UM clinical strategy, integrates physician and nursing review, oversees grievances/appeals, clinical contracting, vendor management, and dental review. Leverages analytics to improve Star Ratings, review consistency, and outcomes while developing clinical leadership and aligning UM with enterprise strategy.

Owns the Medicare Risk Adjustment platform and technical portfolio by translating business needs into technical requirements, prioritizing enhancements, assessing business value, and coordinating business, analytics, and IT delivery teams. The role manages competing priorities, supports technical budgeting, identifies opportunities, escalates insights affecting Stars outcomes, and drives initiatives that maximize platform value. This is a remote position with occasional travel for training or meetings.

Lead the setup and implementation of operational frameworks, processes, and controls for a new VA CCN contract. Partner across claims and financial services teams to identify and implement process improvements, enhance performance, monitor claims and financial inventory, and improve workflows. The role is remote, contingent on contract award and successful transition, and may require occasional travel.

Lead product strategy, backlog management, and platform development for Adobe Experience Platform web integrations across authenticated and unauthenticated channels. Translate business, regulatory, and customer needs into product requirements while partnering with engineering, architecture, marketing, CRM, legal, privacy, and compliance teams. Drive consent, preference, identity, personalization, and downstream activation capabilities; support enterprise adoption; monitor KPIs, data quality, integration health, and compliance risk; and optimize customer experiences across digital and omnichannel platforms.

Manages provider data, audits, relations, credentialing, contract systems, and service-failure processes for health plans. Coordinates administrative workgroups and external vendors, prioritizes daily activities, monitors schedules and goals, and oversees key processes with limited supervision. Requires provider relations or healthcare experience, project management experience, and intermediate Microsoft Office skills. This is a remote role aligned to Central Time with occasional travel.

Sets pricing assumptions and develops Medicare Part D bid pricing models. Analyzes claims, drug utilization, member behavior, market dynamics, drug launches, regulatory changes, and clinical developments to forecast pharmacy costs. Maintains pricing tools and utilization projections, researches cost trends, collaborates with pricing, clinical, pharmacy, formulary, and finance teams, and communicates recommendations to leadership.

Leads contract management, compliance, subcontract administration, procurement oversight, and ethics functions across Federal Government programs. Provides strategic direction and operational oversight to ensure contracts, purchasing, small business commitments, and compliance activities meet FAR, DFARS, regulatory, and organizational requirements.

Review utilization management activities and documentation to ensure policy and regulatory compliance. Collect and analyze outcome and operational metrics, process QIO fast-track appeals and expedited authorizations, make independent determinations, and follow regulatory turnaround times. Work a four-day, 10-hour shift schedule (Wed–Sun or Thu–Sun) in an EST-operating, remote role with strict home-office and internet requirements.

Leads Humana’s enterprise conversational channels and advocate experience portfolio, including IVR, routing, conversational AI, virtual assistants, co-browse, intelligent search, and CRM. Owns product strategy, roadmaps, UX, architecture, delivery, modernization, and outcome measurement across member and advocate journeys. Partners with operations, technology, analytics, and digital teams to improve service quality, productivity, authentication, routing, efficiency, and member outcomes. Requires extensive leadership in product management, contact center technology, enterprise AI, regulated environments, and cross-functional portfolio delivery.

Leads Humana’s enterprise digital platform portfolio, defining multi-year product strategy, investment priorities, adoption plans, governance, and value-realization metrics. Oversees platforms including Adobe Experience Platform, consent management, digital health, design systems, content, and reusable digital services. Partners with business, design, technology, and engineering leaders to align roadmaps, drive enterprise adoption, manage trade-offs, and improve customer and business outcomes. Develops senior product leaders and cross-functional teams in a regulated environment.

Develops and executes Medicare Advantage pricing strategies, establishes assumptions, prepares bids, supports regulatory filings and certifications, implements rates and benefit changes, and advises product leaders. Analyzes market performance, forecasts, competitive conditions, and experience data to recommend pricing actions supporting profitability and membership growth. Requires cross-functional collaboration, actuarial judgment, and compliance with state and federal regulations.

Leads complex analytics initiatives and partners with business leaders to define problems, analyze pharmacy, sales, and operational data, and develop actionable recommendations. Manages engagements across the full analytics lifecycle, from discovery through solution delivery and implementation support. Designs metrics, dashboards, frameworks, and decision-support tools while communicating insights to executive, operational, and technical audiences. The role emphasizes consultative analytics and business problem solving rather than software development or data infrastructure engineering.

Provide non-clinical administrative support for utilization management by following established policies and processes. Complete clerical tasks, maintain accurate records, meet productivity and quality standards, prioritize work, escalate issues beyond guidelines, and collaborate with internal teams. Work is performed under close supervision to support appropriate member care and efficient operational workflows.

Supports corporate accounting operations, including month-end close, journal entries, reconciliations, intercompany transactions, eliminations, mergers and acquisitions, financial reporting, and internal controls. Reviews offshore accounting work, analyzes complex accounting issues, performs ad hoc financial analysis, and contributes to process improvement projects. Requires strong U.S. GAAP knowledge, sound judgment, and cross-functional collaboration.

Performs medical necessity and comprehensive medication reviews for pre-authorizations, analyzes medication care plans and utilization patterns, advises patients/providers to promote cost-effective, quality outcomes, and follows established utilization management guidelines.

Leads the strategy, roadmap, delivery, and continuous improvement of Humana’s enterprise IVR and conversational automation portfolio. The role drives Google GECX-based voice bots, routing, LLM/NLU capabilities, generative and agentic experiences, platform modernization, governance, and measurable customer and operational outcomes. Responsibilities include building product teams, managing enterprise initiatives, partnering cross-functionally, influencing executives, and overseeing risks, dependencies, architecture, and prioritization.

Leads Humana’s enterprise consumer and growth strategy for D-SNP and C-SNP products. Owns the member lifecycle across acquisition, product and benefit design, engagement, retention, customer experience, quality outcomes, and business performance. Partners with Product, Actuarial, Clinical, Marketing, Sales, Digital, and service teams to identify growth opportunities, develop consumer-centric strategies, guide market analysis, establish objectives, present recommendations to executives, and mentor high-performing teams.

Leads actuarial risk and compliance activities for Medicare Advantage and prescription drug plan bid filings. Maintains and runs the CMS Out-of-Pocket Cost Model, interprets results, resolves compliance test failures, supports CMS audits, and develops filing controls and process improvements. The role assesses business risks, advises executives, reviews regulatory practices, and leads actuarial or support staff, including a direct report.

Manages and expands a Western U.S. network of independent health and life insurance agents. Responsibilities include recruiting, onboarding, training, product education, relationship management, sales support, territory growth, agent retention, pipeline tracking, compliance guidance, and performance planning. The role supports Medicare, ancillary health, and life insurance products while collaborating with internal teams to resolve agent issues and achieve sales and renewal goals.