Humana

Vice President

• Define the multi-year vision, product strategy, target outcomes, and enduring roadmap for Humana’s enterprise digital platform portfolio
• Translate enterprise priorities and customer needs into opportunities and validate desirability, viability, quality, and executability before scaling investment
• Own portfolio priorities and investment recommendations
• Own the enterprise design system as a platform product, including roadmap, governance, service model, reusable components, standards, and enablement tools
• Build and execute an enterprise adoption strategy for priority business and customer use cases
• Partner with business and channel product leaders on activation plans, readiness, dependencies, and time to value
• Drive adoption of the enterprise design system across web, mobile, and associate experiences
• Establish enablement, standards, playbooks, communities of practice, and feedback mechanisms
• Establish product operating model decision rights for demand intake, portfolio priorities, capability reuse, funding trade-offs, and lifecycle management
• Lead enterprise and design-system governance, including contribution standards, stage-gate decisions, release priorities, exceptions, and adoption requirements
• Partner with technology and engineering leaders to align product, architecture, and delivery roadmaps
• Lead executive portfolio and investment reviews and manage trade-offs, resources, dependencies, and strategic vendors
• Define portfolio objectives, key results, baselines, targets, and executive scorecards
• Measure adoption, reuse, accessibility, speed to market, customer and business impact, cost reduction, and return on investment
• Use performance insights to validate benefits, reprioritize investment, address adoption gaps, and communicate progress, risks, and decisions
• Lead and develop directors, senior product leaders, and persistent cross-functional platform teams
• Build a customer-focused culture of discovery, experimentation, evidence-based prioritization, enterprise reuse, accountability, and continuous learning
• Strengthen product operating model capabilities, roles, ways of working, succession, and career development across a matrixed enterprise

Associate Vice President – Enterprise Digital Platforms

Human Resources

• Lead the people management agenda in a business unit/area and act as a strategic advisor to senior leadership
• Shape and execute people strategies supporting business priorities, organizational effectiveness, and a high-performing culture
• Align workforce, talent, leadership, and organizational strategies with business objectives
• Provide data-driven insights, organizational consulting, and change leadership in a complex, highly matrixed environment
• Connect talent, compensation, learning, workforce planning, and other HR functions to drive coordinated outcomes
• Translate business priorities into workforce plans, organizational capabilities, leadership strategies, and talent initiatives
• Advise senior leaders on organizational effectiveness, talent management, succession planning, and workforce-related decisions
• Lead organizational design efforts involving role clarity, decision rights, operating models, and team effectiveness
• Drive leadership and succession strategies
• Lead change management through stakeholder engagement, communication, readiness, adoption, and sustainment strategies
• Analyze workforce, talent, and business data to identify trends, assess organizational health, inform decisions, and measure outcomes
• Partner with HR Centers of Excellence and stakeholders to deliver integrated people solutions
• Identify risks, evaluate options, and provide evidence-based recommendations
• Facilitate collaboration across business areas and HR teams
• Drive adoption of HR programs, processes, and best practices
• Advise leaders through organizational changes, leadership transitions, and evolving business priorities
• Contribute to HR capability advancement through knowledge sharing, best practices, and scalable solutions
• Present workforce insights, organizational trends, and strategic recommendations to senior leadership
• Lead confidential and special projects supporting organizational effectiveness and business transformation

HR Business Partner – Lead

Manager

• Assess and evaluate members' needs and requirements by telephone and face-to-face
• Guide members and families toward appropriate care and wellbeing resources
• Monitor care, assessments, and evaluations to ensure members progress toward desired outcomes
• Create member care plans
• Manage behavioral, physical, environmental, and psychosocial health needs using varied strategies and techniques
• Identify and resolve barriers to effective care
• Collaborate with providers and community services to promote quality and cost-effective outcomes
• Coordinate in-person meetings when face-to-face enrollee support is required
• Work collaboratively with an interdisciplinary care management team including community health workers, housing support specialists, SDOH coordinators, and care management support assistants
• Follow established guidelines and procedures

Care Manager – Behavioral Health

Client Services Representative

• Define and execute Humana’s enterprise Contact Center COE strategy and multi-year roadmap
• Establish enterprise standards, policies, decision rights, operating rhythms, and governance forums
• Build and lead a high-performing organization, including succession and talent pipelines
• Oversee end-to-end omnichannel customer journeys across voice, IVR, CRM, chat, messaging, mobile notifications, and emerging channels
• Sponsor enterprise onboarding, role-based learning, certification, knowledge management, and continuous development
• Define enterprise KPIs, scorecards, dashboards, and performance reviews
• Provide executive oversight for contact center platforms, automation, AI-enabled capabilities, and product roadmaps
• Drive continuous improvement in customer satisfaction, quality, compliance, productivity, cost, and employee experience
• Partner with business operations, Digital, Technology, Clinical, Finance, Risk, Compliance, Legal, Procurement, and HR leaders
• Shape business cases, investment decisions, capacity plans, and value realization while ensuring regulatory, privacy, security, accessibility, audit, and operational risk requirements
• Translate strategy into executable plans, govern cross-functional delivery, drive adoption and workforce readiness, manage risks and dependencies, and realize measurable outcomes
• Report to a Senior Vice President and operate across business segments and enterprise functions

VP, COE Client Services

• Own the conversational channel and advocate experience portfolio, including IVR, queuing and routing, AI-enabled customer engagement, Intelligent Search, Virtual Assistant, co-browse, and Customer Care Advocate CRM
• Lead an integrated conversational engagement ecosystem across business segments
• Deliver seamless, AI-enabled experiences across the end-to-end member and advocate journey
• Partner with Consumer Digital product leaders to connect conversational channels with digital self-service
• Define and execute the multi-year contact center advocate experience strategy and product roadmap
• Own product roadmaps and backlog prioritization, sequencing investments and making trade-off decisions
• Establish and track outcomes for member experience, advocate productivity, authentication, misroutes, service quality, and transformation goals
• Develop multi-year product strategies aligned with Insurance and CenterWell business objectives
• Lead UX and interaction design across conversational channels, advocate desktop, and digital capabilities
• Direct technical architecture, integration, release sequencing, and delivery quality
• Evaluate market trends, member and advocate needs, competitive dynamics, and emerging technologies
• Lead products and platforms supporting IVR modernization, conversational AI, Virtual Assistant, co-browse, Intelligent Search, and advocate experience
• Apply insurance and customer service expertise to guide responsible AI use
• Prioritize investments based on business value, customer outcomes, regulatory requirements, and technical sustainability
• Balance enhancement of existing capabilities with innovation and modernization
• Drive simplified, personalized, and connected member and advocate interactions
• Collaborate with contact center operations, technology, analytics, Consumer Digital, and Client Services

Associate Vice President – Conversational Channels

Actuary

• Set pricing assumptions, submit bids, and file and gain approval of premium rates and rate certifications with regulatory agencies
• Support implementation of rates, new plans, and benefit changes
• Provide guidance to Product Development on new product and benefit cost impacts
• Develop and maintain pricing tools for standard and custom benefits
• Establish market-level financial metrics aligned with segment profitability goals
• Analyze market-level results and projections and recommend pricing actions
• Research root causes using market-level projections and experience data tools
• Research competitors and collaborate with market partners on profitable membership growth strategies
• Provide actuarial certifications on rate filings and attest to compliance with state and federal rating and benefit regulations
• Lead 2–3 Medicare Advantage regions
• Review individual Medicare Advantage bids for accuracy and compliance
• Support recurring forecasts and provide financial guidance to leadership
• Participate in cross-functional work groups
• Manage 2–3 direct reports and a total team of 4–7 associates

Associate Actuarial Director – Individual Medicare Advantage

• Develop and execute pricing strategies for Medicare Advantage products
• Establish pricing assumptions
• Prepare and submit bids
• Support regulatory rate filings and certifications
• Help implement rates, new plans and benefit changes
• Advise Product Development on the cost impact of new products and benefits
• Develop and maintain pricing tools for standard and customized offerings
• Establish market-level financial metrics aligned with segment profitability goals
• Analyze results and projections and recommend pricing actions
• Manage forecasting cycles aligned with government-established timelines
• Identify root causes and develop actionable insights using market projections and experience-data tools
• Monitor the competitive landscape
• Collaborate with market partners to support profitable membership growth
• Provide actuarial certifications for rate filings and attest to compliance with state and federal rating and benefit regulations
• Advise executives on significant, segment-specific functional strategies
• Report to the Director, Actuarial Pricing
• Occasionally travel to Humana offices for training or meetings

Actuary, Pricing – Individual MA

• Assess and evaluate members' needs and requirements to achieve or maintain optimal wellness
• Guide members and families toward appropriate care and wellbeing resources
• Manage members' physical, environmental, and psychosocial health issues
• Identify and resolve barriers to effective care
• Engage members and families in recovery and wellness programs using a holistic, member-focused approach
• Conduct telephonic and in-person assessments
• Monitor and evaluate member progress
• Develop individualized care plans using clinical judgment and changes in health status
• Collaborate with providers and community services to ensure quality, cost-effective outcomes
• Coordinate physical health, social determinants of health, and additional benefits
• Facilitate communication across the care team, including PCPs and care transitions
• Provide health and wellness resources to families
• Submit incident reports as required
• Participate in health promotion and community events
• Implement care management activities according to contractual requirements, established guidelines, and Louisiana Department of Health directives
• Conduct face-to-face interactions with members, families, and providers
• Travel within the assigned Louisiana region and attend community engagement activities and team meetings

RN, Field Care Manager – Maternal-Child Health

Architect

• Lead engineers integrating current and future subsidiaries into enterprise technologies, processes, and teams
• Own 14 broad technology platforms during subsidiary integration through the M&A pipeline
• Design and develop IT infrastructure architecture solutions aligned with enterprise architecture direction and standards
• Apply understanding of how organizational capabilities interrelate across departments
• Provide infrastructure and platform ownership across distributed compute, hypervisors, server OS, public cloud, storage, databases, DNS/DHCP, Active Directory, PKI, monitoring, and automation/orchestration
• Perform technical planning and architecture development and modify specifications
• Develop specifications for new IT infrastructure products and service offerings
• Assess compatibility and integration of proposed standard products and services
• Resolve complex technical and operational problems
• Potentially lead multiple managers or highly specialized professional associates
• Marry strategy to tactics through associates and multiple contractor teams
• Travel occasionally to Humana offices for training or meetings

Associate Director – Infrastructure and Architecture

• Lead nurses and support staff responsible for utilization management and prior authorization activities
• Oversee medical necessity and level-of-care reviews for inpatient, outpatient, and behavioral health services
• Ensure authorization decisions comply with regulatory requirements and internal policies
• Monitor productivity, quality, service levels, and operational performance metrics
• Guide resolution and escalation of complex clinical and operational issues
• Educate providers on utilization management, medical necessity, and prior authorization requirements
• Oversee provider outreach activities
• Ensure accurate entry, maintenance, and documentation of clinical information in medical management systems
• Lead process improvement and trend analysis projects
• Support departmental policies, procedures, and workflow standards
• Collaborate with cross-functional partners to address operational challenges and improve outcomes
• Conduct team meetings, coaching sessions, and performance discussions
• Manage departmental resources and workflow
• Promote accountability, quality, collaboration, and continuous improvement

Utilization Management Manager

Project Manager

• Manage all aspects of Medicaid implementation projects from start to finish, ensuring timely and budget-compliant completion
• Plan, organize, monitor, and oversee complex projects using cross-functional teams
• Assist in training and perform duties as the dedicated Project Manager
• Manage the full project life cycle, including requirements assessment, project planning, scheduling, resourcing, budgeting, execution, deployment, and closure
• Maintain project documentation, including meeting minutes, action items, issue lists, project plans, and risk management plans
• Communicate project status to stakeholders and external agencies
• Negotiate with stakeholders to identify resources, resolve issues, and mitigate risks
• Coordinate cross-functional meetings and align stakeholder expectations with company objectives
• Provide functional and technical knowledge across business and technical areas
• Monitor project deliverables, including design documents, test plans, training materials, and operations documentation
• Provide leadership for project teams and motivate members to meet goals and milestones
• Report on project milestones, deliverables, dependencies, risks, and issues to leadership
• Assess interdependencies between technology, operations, and business needs
• Perform internal project quality control and participate in issue resolution
• Define Statements of Work and specifications for Medicaid contracts/RFPs
• Manage project/program expectations, delegate deliverables, and manage issues and risks
• Deliver effective executive-level communication
• Ensure projects and programs meet scope, schedule, budget, and quality standards

Senior Project Manager – Medicaid Implementation

Executive

• Develop and grow positive, long-term relationships with physicians, providers and healthcare systems
• Support and improve financial and quality performance within contracted health plan relationships
• Represent the health plan/provider relationship across financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements, provider performance, member experience, market growth, provider experience and operational excellence
• Advise executives and develop functional strategies, often segment-specific, on matters of significance
• Exercise independent judgment and decision-making on complex issues
• Analyze variable factors and determine the best course of action
• Travel occasionally to Humana offices for training or meetings

Provider Engagement Executive

• Perform telephonic and face-to-face assessments and evaluations for long-term services and support (LTSS) and aged, blind and disabled (ABD) members
• Meet members in the field at their homes or locations of their choice
• Assess members’ goals, needs and barriers
• Connect members and families with appropriate quality services and community resources
• Review, analyze, assess and attest for medical complexity
• Develop individualized member care plans
• Apply evidence-based strategies to manage members’ physical, environmental and psychosocial health
• Identify and resolve barriers to effective care
• Continuously monitor member care and progress toward desired outcomes through comprehensive assessments and evaluations
• Make autonomous decisions in varied and occasionally ambiguous situations
• Follow established guidelines and procedures
• Travel 50–75% for field interactions with members, families and providers
• Occasionally attend onsite meetings at the Humana Healthy Horizons office in Glen Allen, Virginia
• Support members with person-centered health outcomes

RN, Field Care Manager

Insurance

• Oversee a department comprising 7 direct reports and 250 associates leading CM/UM Risk Management, UM and CM audit teams, and policy governance
• Identify, assess, and report operational and clinical risks within CM/UM processes to appropriate governance structures
• Monitor CM/UM compliance and operational metrics, escalating and resolving issues impacting member care or regulatory compliance
• Track, interpret, and implement CMS Federal and Medicaid State regulations affecting CM/UM
• Support regulatory audits focused on CM/UM compliance and facilitate remediation
• Lead risk mitigation efforts for care management and utilization management, including maturity assessments and oversight of issues and opportunities
• Oversee CM/UM business continuity and work across leadership to resolve IOPs
• Foster quality and continuous improvement within CM/UM control processes
• Address legislative and regulatory issues affecting CM/UM operations, including fraud risk identification and mitigation
• Partner with Legal, Compliance, Regulatory Affairs, and business leaders on emerging regulatory and legal risks, legislative requirements, audit and litigation readiness, and alignment with applicable laws
• Report directly to the Senior Vice President – Clinical Operations

VP, Clinical Policy and Risk Management

• Coordinate care for patients with varied healthcare needs
• Assess patients’ healthcare needs and complete telephonic assessments
• Review patient information and clinical documentation
• Identify potential barriers to care and develop appropriate individualized care plans
• Provide education to patients and caregivers and answer questions about plans of care
• Collaborate with physicians, home health clinicians, hospitals, and other healthcare professionals
• Monitor patient progress and identify changes in condition
• Coordinate services and help patients access available healthcare resources
• Use clinical judgment to recognize potential concerns and escalate them
• Document patient interactions accurately and timely
• Maintain confidentiality and follow applicable policies and regulatory requirements