Humana

General

• Assess and evaluate members' needs and requirements to support optimal wellness
• Meet members in their locations and assess needs, barriers, goals and priorities
• Conduct initial and ongoing long-term services and support (LTSS) assessments using person-centered thinking approaches
• Contact members telephonically and/or in person
• Develop and continuously modify service plans
• Involve care-team members in care planning
• Identify LTSS providers and community partnerships
• Support members with LTSS, environmental, social, housing, educational and other services
• Assist members in maintaining Medicaid eligibility
• Prevent duplicative assessments using available member information
• Collaborate with Medical Directors, geriatricians and care coordinators to ensure cohesive service delivery and positive outcomes

Field Service Coordinator

Community Health Worker

• Serve as a liaison between health and social services and the community
• Identify health-related issues, collect data, and discuss concerns with people served
• Support case management functions and address social determinants of health needs
• Improve self-management of chronic conditions and promote prevention and tailored health education
• Work with case managers, housing specialists, SDOH coordinators, ED Liaison, and Redetermination Specialist
• Conduct in-person assessments of member care needs, preferences, socioeconomic barriers, and home environments
• Assess barriers to healthy living and healthcare access; assist with physical and behavioral health appointment scheduling
• Advocate for members with providers, community resources, schools, and other entities
• Navigate healthcare and social service systems and coordinate access to housing, food, income, and transportation
• Promote care-plan adherence and provide motivational interviewing for medication and treatment adherence
• Provide social support and culturally appropriate health education and health coaching
• Attend Humana community events and provide education on case management services
• Conduct research and in-person outreach to locate difficult-to-contact members
• Assist with Health Risk Screenings and Welcome Calls
• Build relationships with providers and community resources and identify community resource gaps
• Support Humana's Readmission Prevention and ED Diversion program
• Perform other duties as assigned

Vice President

• Set the strategic direction for clinical programs and products serving Medicare Advantage and Traditional Medicare populations
• Translate enterprise priorities into scalable home-based care models
• Lead a team of approximately 20 associates
• Partner across Home, Pharmacy, Primary Care, and Humana to identify opportunities
• Build business cases, launch pilots, and scale programs
• Develop the roadmap for clinical programs improving HH and MA Stars performance, affordability, risk adjustment, and member outcomes
• Oversee day-to-day execution of strategic clinical programs, including performance management, issue resolution, and cross-functional coordination
• Lead gap closure and quality improvement efforts
• Expand appropriate Home Health utilization and demonstrate network savings, member impact, and operational requirements
• Scale interventions reducing hospitalizations, readmissions, emergency department utilization, and other avoidable costs
• Build programs improving outreach, participation, adherence, and longitudinal care management
• Develop services and home-based care models for high-risk members outside traditional Home Health episodes
• Strengthen clinical integration across CWHH, PCO, Rx, and Humana through shared workflows, data, care pathways, and operating routines

Associate VP, Clinical Product – Strategy

Product Manager

• Participate in lightweight architecture, design, and code review
• Define and own product vision, strategy, and roadmap for assigned IT products and platforms
• Collaborate with business leaders, users, architects, developers, and infrastructure teams to gather and prioritize requirements
• Lead product lifecycle activities from ideation and planning through implementation and ongoing optimization
• Translate business needs into detailed technical requirements, user stories, and acceptance criteria
• Partner with engineering teams to ensure solutions meet security, scalability, performance, and compliance requirements
• Manage product backlogs and prioritize initiatives based on business value, risk, and technical dependencies
• Drive implementation and rollout of new applications
• Serve as escalation point for product-related issues and incidents
• Facilitate Agile ceremonies, sprint planning, and release coordination where applicable
• Serve as primary stakeholder contact and provide regular updates on product progress and outcomes
• Identify opportunities for automation, process improvements, and technology modernization
• Support vendor evaluations, technology assessments, and implementation projects

Technical Product Lead

Advisor

• Lead organizational strategic planning efforts defining OneHome’s long-term growth agenda
• Facilitate strategic planning processes and establish executable roadmaps
• Conduct research, expert interviews, and analytical evaluations to identify opportunities and operational gaps
• Assess complex opportunities for value, feasibility, growth, and improved member care
• Develop high-level product requirements and realistic strategic roadmaps
• Support governance and oversight of OneHome’s strategic initiative portfolio
• Establish prioritization frameworks, monitor initiative performance, and identify risks and dependencies
• Provide leadership transparency through regular reporting and business reviews
• Coordinate multifaceted teams and monitor strategic program progress
• Develop business cases, strategic recommendations, transformation roadmaps, executive dashboards, leadership briefings, Board materials, and enterprise communications
• Support informed decision-making and organizational alignment across OneHome, CenterWell, and Humana

Strategy Advancement Advisor

Pharmacist

• Monitor the drug development pipeline and medical literature
• Provide clinical support for internal stakeholders
• Develop and/or implement strategies and programs to reduce cost trend and improve health outcomes
• Develop and operationalize formularies for coverage, utilization management edits, or clinical coverage policies for pharmacy and medical administered drug products
• Analyze drug use trends to evaluate and inform formulary strategies
• Collaborate on research projects and develop research project proposals
• Develop corporate communications for senior leadership
• Conduct analysis of drug spend, utilization, and/or approval scenarios to support trend management
• Advise executives on functional strategies, often segment-specific
• Exercise independent judgment and decision-making on complex issues with minimal supervision
• Report to a leader and participate in the HPS Clinical Program Strategy team
• Occasionally travel to Humana offices for training or meetings

Clinical Pharmacist – Lead

Auditor

• Perform audit projects and consulting engagements following established methodology and within budgeted timeframes
• Independently prepare audit workpapers following Institute of Internal Audit and departmental standards
• Participate in audit planning, fieldwork, and reporting phases of engagements
• Identify audit issues and root causes
• Recommend improvements
• Ensure management develops and implements corrective action plans
• Communicate audit and consulting project results to management through written reports and oral presentations
• Evaluate the efficiency and effectiveness of Humana's operational processes
• Execute audit plans
• Prepare reports for management on risk audit results

Internal Auditor

Platform Engineer

• Maintain and support services across the full NBA platform and understand how components integrate
• Monitor platform health and investigate and resolve production issues, bottlenecks, failures, and scaling constraints
• Design and ship focused features, enhancements, and technical improvements across platform components
• Extend logging, metrics, tracing, and alerting for production visibility
• Profile and tune components under load to improve performance and scalability
• Write tests, participate in code reviews, and uphold engineering standards
• Participate in the on-call rotation and lead root-cause analysis
• Convert incidents into durable fixes and preventative improvements
• Work with delivery pods and Decision Intelligence to understand new components and assume long-term ownership

Senior Platform Engineer

Customer Support

• Process sales invoices
• Draft sales documents, proposals, reports, correspondence, sales contracts, and maintenance agreements
• Compile and complete standard calculations for reporting statistics
• Gather background research on member accounts, prospects, competitors, and industry trends
• Communicate with staff in other organizational areas to confirm order status and resolve member complaints
• Maintain up-to-date member records
• Collate marketing materials and prepare information for team meetings
• Answer internal and member inquiries
• Provide sales administrative support for onboarding and retaining members
• Support sales administration and Medicare sales leadership, sales representatives, and external agents
• Complete administrative tasks and projects independently with limited guidance
• Complete general administrative duties

Sales Support Representative

• Contribute to study conceptualization, literature reviews, and proposal writing
• Develop study protocols
• Execute statistical analyses according to study protocols under supervision of experienced research scientists
• Report and interpret results
• Contribute to manuscript development
• Participate in research teams and support research activities
• Synthesize, communicate, and present research findings to Humana stakeholders
• Conduct research involving comparative effectiveness, disease characterization, treatment patterns, cost and healthcare utilization, medication access and affordability, pharmacy benefit design, utilization management, and pharmacy policy evaluation

Healthcare Research Intern

Compliance

• Oversee compliance activities related to sales operations
• Provide oversight and governance for sales channels
• Ensure adherence to federal, state, and organizational requirements
• Develop, implement, and maintain compliance policies, procedures, and controls for sales monitoring and oversight
• Lead efforts to identify, assess, and mitigate potential compliance risks
• Collaborate with Sales Leadership and Operational teams to address compliance concerns and implement corrective actions
• Analyze emerging regulatory changes and communicate impacts to stakeholders
• Prepare reports and presentations for leadership on compliance performance, findings, and risk mitigation

Associate Director, Compliance – Sales

• Perform data entry into the medical management system
• Assign appropriate providers
• Review referrals for benefits
• Pend referrals to a nurse or supervisor for medical necessity review or additional information
• Recognize sensitive diagnoses and referrals requiring Case Management and route them appropriately
• Apply knowledge of TRICARE benefits and limitations, Humana Military referral processes, MOUs with MTFs, and referral and UM policies
• Answer questions and contact MTFs or civilian providers to obtain additional information
• Assign appropriate ICD10 and CPT codes to referrals
• Process referrals and authorizations according to cycle-time and quality standards, including contingency operations
• Enter information into MSR and other required systems
• Update beneficiary contact information accurately and promptly
• Prepare and submit reports of findings
• Maintain complete and accurate files
• Respond to unexpected operational needs
• Complete assigned projects and duties
• Participate in process and performance improvement activities
• Process referrals from Military Treatment Facilities and civilian providers under direct clinical supervision
• Perform routine administrative, clerical, operational, customer support, and computational tasks

Referrals Coordinator

Strategy

• Conduct analysis and/or work streams within high-profile, high-impact strategy projects
• Participate in interviews and working sessions with leaders within Medicare and Medicaid and across the broader organization
• Conduct industry, market, competitor, and financial analysis
• Identify insights for Humana
• Create high-quality analysis and deliverables framing objectives, issues, and challenges
• Articulate insightful findings and recommendations
• Collaborate with fellow team members and leaders across the company
• Shape implementation considerations
• Work with business owners to transition analysis into execution
• Support Enterprise Growth’s priority strategy projects, with emphasis on Medicare Advantage strategy development

Growth Strategy Consultant

• Manage multiple high-profile, high-impact strategy projects
• Lead interviews and working sessions with leaders within Enterprise Growth and across the broader organization
• Lead teams conducting industry, market, competitor, and financial analysis
• Distill analytical insights for Humana
• Create high-quality analysis and deliverables that frame objectives, issues, and challenges
• Articulate insightful findings and recommendations
• Shape implementation considerations and work with business owners to transition analysis into execution
• Collaborate with fellow team members, subject matter experts, executive Management Team members, and corporate, functional, and business unit leaders
• Synthesize strategic choices into a coherent plan to drive growth and profitability and improve members’ lives and health
• Facilitate critical meetings, drive diverse groups to consensus, and lead through influence
• Travel occasionally to Humana offices for training or meetings

Growth Strategy Principal

Account Manager

• Lead Group Medicare account management performance, client retention, experience, renewal readiness, and continuous improvement
• Translate client engagement strategy into consistent execution across an assigned portfolio, team, or functional area
• Lead client value delivery and tailor account plans based on risk, value, and client needs
• Build senior client relationships and lead governance forums, business reviews, and escalated issue resolution
• Coordinate Sales, Pricing, Finance, Network, Stars, Clinical, Operations, Digital, Marketing, and Product partners
• Promote Stars and clinical actions to improve health outcomes and CMS Stars metrics
• Monitor account performance, financial metrics, client satisfaction, risks, and opportunities
• Develop contract amendments, obtain legal approval, and secure renewal package signatures
• Lead renewal planning, RFP activities, negotiations, pricing coordination, and renewal deliverables
• Oversee implementation of new business and renewals, including implementation planning and ongoing management support
• Serve as an escalation point for account management, sales, implementation, internal partners, and clients
• Implement AI and automation capabilities across Account Management workflows
• Identify and scale automation use cases in renewal preparation, reporting, meeting follow-up, member engagement, and knowledge management
• Drive Client and Member NPS improvement through feedback analysis, root-cause prioritization, onboarding, service, communications, and outreach improvements
• Build and sustain a high-performing, client-centric team; set goals, coach employees, address performance gaps, and support succession readiness
• Conduct monthly or more frequent meetings with assigned Sr. AEs, AEs, and CEPs
• Set retention targets and ensure associated sales incentive payments are accurate