Humana

Medical Director

• Provide clinical leadership for Medicaid behavioral health utilization management
• Review complex behavioral health requests and clinical records across levels of care and specialty services
• Apply clinical criteria, Medicaid policies, state regulations, evidence-based national guidelines, and Medicaid requirements
• Make timely, consistent, and defensible medical-necessity determinations
• Conduct peer-to-peer consultations and discussions
• Support utilization reviews, appeals, provider disputes, state fair hearings, audits, and regulatory activities
• Collaborate with providers and internal partners
• Participate in case consultations, training, and process improvement
• Manage high-volume, time-sensitive work and provide coverage during absences, holidays, and on-call rotations
• Maintain confidentiality and comply with privacy, security, credentialing, and organizational requirements
• Report to the Lead Behavioral Health Medical Director or another designated physician leader

Medical Director, Medicaid

Cloud Engineer

• Support development and operations of Enterprise API platforms such as APIGEE within hybrid cloud and on-premises infrastructure
• Implement the Enterprise API Platforms Engineering and Operations strategy through design, planning, integration, maintenance, and support
• Develop specifications for new IT cloud computing products and service offerings
• Implement API solutions using API Management platforms, including API proxies, rate limiting, security, and analytics
• Implement software to monitor and manage Enterprise API and Integration platform environments, networks, systems, and applications
• Work with architects to establish CI/CD pipelines for efficient and secure software integration and delivery
• Collaborate with API and Integration platform architects on design, implementation, testing, production deployment, and support
• Facilitate development and communication of solutions to technical and business stakeholders
• Identify technical dependencies and roadblocks and work with cross-functional teams to remove them
• Travel occasionally to Humana offices for training or meetings as required

Senior Cloud Solutions Engineer

Full-stack Engineer

• Design, code, and maintain software applications meeting business and platform requirements
• Deliver technical solutions and hands-on development expertise within a team environment
• Contribute to Appian platform administration
• Apply strong technical knowledge within the Appian domain
• Develop code that accelerates impactful initiatives in a HIPAA-regulated environment
• Design and develop software solutions using Appian process models, SAIL interfaces, record types, expression rules, AI enablement, and reusable components
• Configure and optimize the Appian platform and address technical issues
• Develop and maintain integrations between Appian and other systems using RESTful services, APIs, and enterprise data sources
• Support workflow and case management solutions based on Appian
• Evaluate and implement Appian platform features and upgrades
• Promote Appian best practices and alignment with engineering standards

Senior Software Engineer – Appian Platform

Data Engineer

• Design, develop, and maintain scalable data pipelines and workflows using Azure Databricks
• Develop and maintain SAS programs and SSIS packages for intermediate and downstream data processing
• Write, optimize, and maintain complex SQL queries for data transformation and analytical use cases
• Design and build ETL/ELT pipelines integrating multiple internal and external source systems
• Select, implement, and support Big Data tools and frameworks
• Monitor, troubleshoot, and resolve complex data processing issues using root cause analysis and preventative fixes
• Optimize data pipelines for performance, scalability, reliability, and cost efficiency
• Recommend and support infrastructure improvements for evolving data volume and processing demands
• Partner with product management and SRE teams to define requirements and translate them into engineering work
• Collaborate with engineers, stakeholders, and cross-functional teams on data strategy, architecture, and outcomes
• Contribute to data and software solutions leveraging big data, artificial intelligence, and machine learning to produce actionable insights

Senior Data Engineer

Pharmacist

• Evaluate the suitability of pharmacotherapy for high-risk patients with chronic conditions, including diabetes, hypertension, heart failure, and COPD
• Execute clinical protocols allowed by the organization and state regulatory agencies
• Optimize drug coverage benefits, including preferred formulary products, lower-cost alternatives, and home delivery pharmacy
• Collaborate with physicians, nurses, and other healthcare professionals to optimize patient care
• Participate in multidisciplinary high-risk rounds and adjust treatment plans
• Counsel patients and communicate complex medical information to patients and healthcare providers
• Educate patients on disease states, medication use, and self-management
• Engage in quality improvement initiatives focused on medication safety and efficacy
• Perform post-discharge medication reconciliation for high-risk transition-of-care patients
• Document clinical activity in the clinic EMR and other pharmacy or clinical management systems
• Support CMS Stars and HEDIS quality measures
• Maintain accurate documentation of clinical interventions and patient care activities
• Conduct in-service education and training for healthcare staff
• Develop and share pharmacotherapy educational materials
• Stay current with pharmacotherapy advancements and clinical guidelines
• Consult healthcare providers on complex medication management issues
• Provide support within the pharmacist's defined scope of practice to advance organizational goals
• Implement targeted initiatives and priorities as directed by Pharmacy leadership
• Report to the Associate Director Integrated Clinic Pharmacist and integrate pharmacy into the physician-practice care team

Senior Integrated Clinic Pharmacist

Technical Product Manager

• Lead development of next-generation digital pharmacy experiences and reusable technical capabilities
• Shape product direction, define and prioritize capabilities, and maintain an executable product backlog
• Partner with Product, Design, Engineering, Analytics, Architecture, and business teams to identify customer problems and opportunities
• Translate customer needs, business opportunities, and market insights into product priorities, capabilities, and roadmaps
• Define MVPs and incremental releases
• Establish product outcomes and use customer insights, analytics, and operational data to inform prioritization
• Translate product strategy, customer journeys, and experience designs into a prioritized, development-ready backlog
• Define features and write and refine user stories, acceptance criteria, and business rules
• Lead backlog refinement and grooming with Engineering
• Maintain connections between outcomes, capabilities, features, stories, dependencies, and releases
• Identify edge cases, system behaviors, data requirements, integrations, technical dependencies, and non-functional requirements
• Participate in technical discovery, solution design, refinement, and delivery discussions
• Evaluate technical options and constraints, surface dependencies, challenge assumptions, and make product tradeoffs
• Identify reusable components, APIs, services, business rules, and platform capabilities
• Balance near-term delivery with investments in scalable technical foundations
• Rapidly test new digital pharmacy experiences and capabilities as an incubator
• Establish measurement and learning plans with Analytics
• Identify successful capabilities to harden, standardize, and scale
• Identify dependencies and establish sequencing for end-to-end delivery
• Validate delivered capabilities against customer experience, business rules, acceptance criteria, and product outcomes
• Continuously evolve the backlog based on discovery, development, and production usage

Lead Technical Product Manager – Digital Pharmacy

Network Engineer

• Lead, mentor, and develop Data Center Network Engineers and Deployment Engineers
• Establish technical roadmaps, engineering standards, deployment methodologies, and automation strategies
• Build a culture of engineering excellence, innovation, accountability, and continuous improvement
• Own engineering execution for major infrastructure initiatives from design through deployment, production acceptance, and operational handoff
• Lead engineering and deployment efforts for modern data center network architectures using Cisco and Arista technologies
• Enable AI-ready networking platforms supporting NVIDIA GPU and high-performance computing environments
• Establish Infrastructure as Code and automated deployment practices using Azure DevOps, Terraform, Ansible, Python, Git, and related technologies
• Lead data center migrations, consolidations, merger and acquisition integrations, and subsidiary onboarding activities
• Drive adoption of orchestration, automation, observability, and telemetry platforms across the data center environment
• Partner with Cloud Engineering, Security Engineering, Infrastructure Engineering, Operations, and Architecture teams
• Provide technical oversight and strategic direction for network, security, visibility, and management platform deployments
• Manage cross-functional programs involving engineering, deployment, operations, security, architecture, and business stakeholders

Associate Director, Network Engineering

Representative

• Respond to customer inquiries by phone, digital, or written channels
• Address benefits questions, resolve issues, and provide member education
• Accurately document customer interactions, requests, concerns, and resolutions
• Research and resolve customer issues, escalating complex or unresolved matters
• Apply established policies, procedures, and resources to provide accurate and timely support
• Use critical thinking and sound judgment to recommend solutions
• Manage workload, prioritize tasks, and meet quality and service expectations
• Work independently within established guidelines to support customer satisfaction and business objectives

Inbound Contact Representative

Product Manager

• Define and communicate product vision, strategy, roadmaps, and modernization priorities for enterprise pharmacy capabilities and platform services
• Translate strategic objectives, customer needs, and operational challenges into prioritized capabilities and product investments
• Establish value hypotheses, business outcomes, success measures, and KPIs
• Own, maintain, and prioritize the product backlog
• Define and refine epics, features, user stories, and acceptance criteria with stakeholders, architects, and engineering teams
• Balance platform investments, regulatory requirements, operational commitments, and business priorities
• Ensure solutions meet Humana technology standards, quality expectations, and customer needs
• Lead product strategy and execution for modernized pharmacy capabilities and shared platform services
• Drive workflow transformation, automation, and process simplification
• Advance reusable, API-first, event-driven, and cloud-enabled capabilities
• Guide retirement and modernization of legacy systems
• Build alignment across business, operations, technology, architecture, engineering, and vendor organizations
• Lead product reviews, roadmap planning, backlog prioritization, and capability planning
• Manage cross-team dependencies and resolve competing priorities
• Influence decisions through data-driven recommendations and product expertise
• Define, monitor, and report KPIs for efficiency, reliability, cycle time, automation, platform adoption, and customer experience
• Measure and communicate value realization through productivity, resiliency, workflow simplification, and legacy modernization outcomes
• Drive continuous improvement and scale successful platform capabilities across the pharmacy ecosystem

Lead Product Manager

Manager

• Identify and resolve barriers that hinder effective care
• Continuously monitor patient care through assessments and evaluations
• Ensure members progress toward desired outcomes
• Create plans of care
• Communicate with internal and external stakeholders
• Apply department, segment, and organizational strategy and operating objectives
• Follow established guidelines and procedures
• Visit Medicaid members in homes, Supportive Living Facilities, Long-Term Care Facilities, and other care settings
• Travel 75–90% locally in the field
• Attend occasional onsite work at the market office in Schaumburg, Illinois
• Travel occasionally to Humana offices for training or meetings

Field Care Manager, RN

Technical Project Manager

• Oversee highly complex IT system projects and/or programs
• Assemble and lead project teams
• Identify required resources and develop project schedules
• Manage stakeholder partnerships and mitigate risks
• Coordinate team activities according to system scope, project objectives, and team-member roles
• Oversee interdependencies and integration of related projects when managing programs
• Set strategies and lead program execution to deliver long-term business value
• Apply ITIL frameworks to manage technology-project risks and issues
• Make decisions regarding technical approaches for project components
• Manage demanding initiatives with executive-level leadership visibility
• Provide stakeholder management instrumental to project success

Senior IT Project Manager

• 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 using varied strategies and techniques
• Identify and resolve barriers that hinder effective care
• Monitor patient care through assessments and evaluations to ensure progress toward desired outcomes
• Create plans of care
• Communicate with internal and external stakeholders
• Visit Medicaid members in homes, Supportive Living Facilities, Long-Term Care Facilities, and other care settings
• Conduct 75-90% local field travel within Illinois

Principal

• Lead Humana's enterprise strategy for provider network transition and disruption management initiatives
• Assess member, provider, operational, regulatory, and business impacts of provider network changes
• Serve as enterprise lead for provider termination and provider network transition programs
• Partner with Provider Contracting, Market Leadership, Member Retention, Stars, Provider and Member Service, Compliance, Provider Network Operations, and other stakeholders
• Develop and implement mitigation strategies
• Identify emerging provider network risks and opportunities and recommend actions to senior leadership
• Improve provider and member experiences while reducing operational friction and execution risk
• Facilitate executive governance and decision-making for provider network transitions and enterprise risk mitigation
• Develop reporting, analytics, executive communications, and performance monitoring for significant provider network events
• Evaluate impacts on member retention, access to care, network adequacy, Stars performance, service operations, and overall business performance
• Lead cross-functional process simplification and coordination efforts
• Influence leaders across a matrixed organization to drive accountability and remove barriers without direct operational ownership
• Advise senior leaders and executives on strategic initiatives, organizational risks, and opportunities
• Identify and prioritize opportunities to strengthen Humana's provider network transition capabilities

Principal – Provider Network Transition Strategy

Project Manager

• Lead end-to-end project delivery, including planning, execution, and successful project outcomes
• Define project scope, objectives, timelines, deliverables, and success metrics aligned with business goals
• Monitor project performance, manage risks and issues, and implement corrective actions
• Facilitate governance processes, executive reporting, and stakeholder communications
• Partner with clinical, operational, technology, compliance, vendor, and business leaders to gather requirements and drive alignment
• Coordinate cross-functional implementation and process improvement activities supporting operational readiness, deployment, and adoption
• Manage project forecasting, compliance requirements, and adherence to organizational standards and governance practices
• Apply project management best practices and contribute to continuous improvement initiatives
• Report to the Associate Director, Program Management and PMO
• Work Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Standard Time

• Lead and develop a team of provider-facing associates
• Serve as subject matter expert on CMS Stars, HEDIS, CAHPS, and HOS
• Oversee external discussions with provider partners to drive performance improvement, workflow optimization, and outcome monitoring
• Collaborate across Provider Engagement, Stars, MRA, Interoperability, Clinical, Provider Contracting, Leadership, and other business partners
• Align team priorities and execution with enterprise, regional, and departmental KPIs and OKRs
• Lead cross-functional meetings and strategic initiatives
• Analyze data, identify insights and opportunities, and communicate findings to leadership and the team
• Develop data-driven education and resources to support team performance
• Oversee daily operations and strategic execution for direct reports
• Monitor and report team and initiative performance results
• Foster a culture of engagement, well-being, and professional development

Medical Director, Medicaid

Senior Cloud Solutions Engineer

Senior Software Engineer – Appian Platform

Senior Data Engineer

Senior Integrated Clinic Pharmacist

Lead Technical Product Manager – Digital Pharmacy

Associate Director, Network Engineering

Inbound Contact Representative

Lead Product Manager

Field Care Manager, RN

Senior IT Project Manager

Field Care Manager, RN

Principal – Provider Network Transition Strategy

Project Manager

Manager, Network Performance