Humana

Manager

• Assess and evaluate members' needs and requirements in a telephonic behavioral health environment
• 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
• Continuously monitor patient care through assessments and evaluations
• Ensure patients progress toward desired outcomes
• Create member care plans as needed
• Make independent decisions regarding work methods and courses of action
• Report to the Regional CM Manager
• Travel up to 50% of the time for mandatory field work
• Occasionally travel to Humana offices for training or meetings

Care Manager, Telephonic Behavioral Health

General

• Collaborate with the Lead to provide operational and strategic support for Application Operations Center and Post Production Validation teams
• Identify, evaluate, and implement automation opportunities to increase efficiency and reduce manual workload
• Recommend and deploy advanced tools and methodologies for application operations and validation
• Analyze workflows and develop standard operating procedures and best-practice documentation
• Oversee daily application support and monitoring to ensure system stability, performance, and reliability
• Coordinate task execution with onshore and offshore teams
• Develop and maintain KPI dashboards and reports for leadership
• Ensure automation and process improvements comply with organizational standards and regulatory requirements
• Facilitate knowledge sharing, training, and change management activities
• Gather stakeholder requirements, understand challenges, and communicate progress on automation initiatives
• Support testing strategies aligned with Humana's Quality Enablement and Test Strategy guidelines

Senior Technology Leadership

Bilingual

• Visit Medicaid members in their homes, Assisted Living Facilities, Long Term Care Facilities, and other care settings
• Travel locally 75–90% of the time
• Assess and evaluate members’ needs and requirements
• Establish member-specific care plans
• Ensure members receive services in the least restrictive setting
• Plan and implement interventions
• Coordinate services and monitor and evaluate case management plans against members’ personal goals
• Guide members and families toward appropriate care resources
• Facilitate interactions with payer sources, providers, interdisciplinary teams, and others involved in members’ care
• Report to the Regional Care Coach Manager
• Work Monday–Friday, 8:30 a.m.–5:00 p.m.

Bilingual Field Care Coordinator

• Assess and evaluate Medicaid members' needs and requirements
• Visit members in homes, assisted living facilities, long-term care facilities, and other care settings
• Coordinate services and resources to support members' optimal wellness
• Establish member-specific care plans
• Ensure members receive services in the least restrictive setting
• Plan and implement interventions
• Monitor and evaluate case management plans against members' personal goals
• Guide members and families toward appropriate care resources
• Facilitate interaction with payer sources, providers, interdisciplinary teams, and others involved in members' care
• Identify and resolve barriers to effective care
• Continuously monitor patient care through assessments, data, conversations, and active care planning
• Travel locally 75–90% of the time
• Report to the Regional Care Coach Manager

Field Care Coordinator – Bilingual Preferred

Procurement

• Lead enterprise strategy for contingent workforce, outsourcing and offshoring, consulting and clinical services
• Serve as senior Procurement partner and trusted commercial advisor to Insurance segment and Corporate Services leadership
• Translate business strategy, operating plans, transformation roadmaps, workforce needs and financial commitments into integrated services, workforce and supplier strategies
• Evaluate make, buy, build, automate, offshore, outsource and partner alternatives before supplier selection
• Create alignment across business, Finance, HR, Legal, Risk, Compliance, Technology and Procurement
• Own enterprise category strategies and build integrated external workforce strategies
• Design location and delivery-model strategies and advance global business services models
• Establish multi-year category strategies and maintain a pipeline of transformation, sourcing, demand-management, insource/outsource, supplier optimization and commercial-model opportunities
• Create rigorous business cases for outsourcing, offshoring, consulting and workforce transformation
• Validate assumptions and track in-year, run-rate and realized value with Finance
• Define decision gates and executive accountabilities through sourcing, transition, stabilization and benefit realization
• Lead or sponsor complex, high-value and high-risk services negotiations
• Design rate-card, milestone, transaction, consumption, capacity, managed-service, outcome-based, gainshare and hybrid commercial models
• Strengthen contractual protections for pricing, productivity, benchmarking, service levels, innovation, change control, audit, transition, termination and exit assistance
• Define contingent workforce strategy, governance and supplier architecture
• Improve demand planning, talent-channel selection, rate and markup governance, supplier performance, tenure management, worker quality and speed to productivity
• Establish consulting strategies, preferred-partner models and governance
• Build category and supplier strategies for clinical services while balancing quality, access, outcomes, cost, compliance, delegation and continuity
• Lead, coach and develop Category Managers, Supplier Managers and procurement professionals
• Build capabilities in global business services, outsourcing, workforce economics, consulting, clinical services, business-case development, transition management, negotiation and executive influence
• Embed analytics, automation and AI into market intelligence, business cases, negotiations, contracts and supplier monitoring
• Establish performance standards, succession plans and development opportunities

Associate VP, Services Procurement

Assistant

• Review inbound referrals and correspondence for processing, fulfilment, or resolution
• Screen physician orders and documentation for required medical information
• Request additional information from referring entities when necessary
• Verify benefits coverage and service eligibility under Health Plan contracts
• Review referral data against medical terms, diagnoses, and procedure codes
• Approve requests or refer them for further review according to established procedures
• Educate members and providers about referral management, medical benefits, referral status, and prior authorizations
• Confirm patient demographics and explain requested services and care
• Coordinate timely delivery of care and services with providers
• Communicate referral determinations to referring entities, providers, and members
• Maintain detailed documentation of patient, physician, referral source, and provider interactions
• Collaborate with Pre-Authorization, Utilization Management, Billing, Pharmacy, and Home Care
• Maintain knowledge of CPT, HCPC, and ICD-10 codes, insurance contracts, Medicare/Medicaid criteria, and Health Plan policies
• Adhere to federal and state regulations concerning patient confidentiality, release of information, and HIPAA
• Protect patients’ personal information
• Report service-delivery delays to the manager
• Ensure work meets quality standards and provide excellent internal and external customer service

Care Management Support Assistant

Product Manager

• Conceive, develop, deliver, and manage products for customer use
• Lead all phases of the product life cycle from inception through marketplace introduction
• Develop products to meet customer needs and achieve cost and success outcomes
• Monitor product efficacy after launch
• Use customer and business partner feedback to ensure products meet customer needs across segments
• Adjust products over time to maintain desired outcomes
• Implement new or updated programs and large-scale projects
• Support technical and operational procedures and processes
• Implement strategic plans and drive goals and objectives
• Improve performance and provide input into functional strategy
• Report to the Associate VP, Mail Order Pharmacy Distribution

Director, Product Management

Representative

• Assign cases to team members for submission to an independent entity for second-level review
• Monitor and record the number of cases assigned to the team
• Monitor distribution of cases among individual associates
• Operate within established guidelines to meet work expectations and quality standards
• Prioritize tasks and manage timelines with minimal supervision
• Adapt to evolving processes and a fast-paced work environment
• Perform thorough reviews of clinical documentation to assess grievances, appeals, and additional requests
• Provide final determinations through collaboration with clinical and other Humana teams

Grievances & Appeals Representative

• Contribute to administration of care management
• Provide non-clinical support for assessing and evaluating members' needs and requirements
• Guide members and families toward appropriate care and well-being resources
• Facilitate interaction with resources supporting member care and well-being
• Perform varied, moderately complex administrative, operational, and customer support assignments
• Perform computations
• Interpret area or department policies and methods for completing assignments
• Identify work expectations and quality standards within defined parameters
• Prioritize and schedule work with minimal direction
• Follow standard policies and practices with some independent discretion

Nurse

• Provide nursing services as ordered on the patient plan of care
• Report problems and potential problems to the RN/Case Manager
• Participate in the nursing process and provide input to the client's plan of care
• Implement care plans as written
• Evaluate care plan effectiveness and recommend revisions
• Record pertinent observations and treatments according to Agency policies
• Provide emotional and physical comfort and safety for clients
• Perform trained nursing procedures
• Notify appropriate personnel about unusual symptoms or changes in client condition
• Participate in case conferences, meetings, and performance improvement activities
• Maintain patient and business confidentiality

Licensed Practical Nurse

Artificial Intelligence

• Lead and mentor teams developing production-ready AI solutions that improve healthcare delivery, member experiences, and business operations
• Help define and execute the roadmap for applied AI initiatives aligned with enterprise priorities and business needs
• Guide evaluation and adoption of machine learning, generative AI, large language models, multimodal models, and intelligent agent technologies
• Oversee scalable APIs, frameworks, data pipelines, retrieval-augmented generation solutions, and agent orchestration capabilities
• Partner with product, data science, engineering, architecture, security, and business teams to translate requirements into reliable solutions
• Establish standards for AI evaluation, observability, performance, security, privacy, maintainability, and operational excellence
• Promote responsible AI practices and compliance with applicable healthcare, data privacy, and security requirements
• Stay current with AI technology and recommend practical opportunities supporting Humana’s mission and business goals

Associate Director, Applied AI

Actuary

• Support value-based initiatives within the HealthCare Economics team
• Partner with actuarial, finance, analytics, and business teams
• Design and develop holistic modeling solutions from the ground up
• Develop methodologies and frameworks supporting performance measurement, financial reconciliation, and strategic decision-making
• Analyze and forecast claims and revenue trends
• Develop innovative forecasting methodologies
• Translate complex business requirements into scalable analytical solutions
• Evaluate data, identify gaps, propose holistic approaches, and develop end-to-end solutions
• Design forecasting methodologies and establish reporting metrics
• Validate model results
• Support the evolution of value-based care analytics
• Apply department, segment, and organizational strategy and operating objectives to the work
• Make decisions regarding work methods and recommend and execute appropriate courses of action with limited guidance

Actuarial Analyst

• Analyze and forecast financial data for strategic and operational decisions
• Establish metrics and provide data analyses supporting business intelligence
• Maintain the provider revenue and expense projection model and associated tools
• Integrate value-based provider impacts into financial and bid forecasts
• Manage tools associated with value-based provider impacts
• Provide guidance on effective risk modeling practices
• Develop and execute processes and controls around data flow to ensure data integrity
• Collaborate with stakeholders to understand business needs and issues
• Troubleshoot problems and conduct root cause analysis
• Develop cost-effective resolutions for data anomalies
• Understand department, segment, and organizational strategy and operating objectives
• Make decisions regarding work methods in occasionally ambiguous situations
• Report to the Actuary, Analytics/Forecasting

QA Engineer

• Carry out procedures to ensure information systems products and services meet organization standards and end-user requirements
• Lead and perform software tests to ensure proper operation and freedom from defects
• Create test data for applications
• Document and resolve complex problems
• Report progress on problem resolution to management
• Devise improvements to current procedures and develop models of possible future configurations
• Act as an information resource about assigned areas to technical writers
• Perform complex workflow analysis and recommend quality improvements
• Coordinate intradepartmental activities
• Develop and implement strategic plans aligned with Segment or Business strategy
• Lead and develop a team of associates

AVP, Quality Engineering – CenterWell Segment

Solutions Engineer

• Serve as the strategic technology leader for Provider engagement and related provider experience capabilities
• Partner across a matrixed organization to align business priorities, regulatory requirements, architecture standards, and technology investments
• Provide strategic direction and oversight for new programs, platform enhancements, and large-scale technology initiatives
• Establish engineering best practices, delivery discipline, operational excellence, and continuous improvement
• Lead development and execution of a comprehensive Provider engagement strategy
• Define the end-to-end provider experience target state, roadmap, and investment priorities
• Drive adoption of modern CRM capabilities, AI-powered solutions, automation, and emerging technologies
• Lead delivery and modernization of provider-facing and associate-facing technology solutions
• Drive execution across multiple teams and technology domains
• Promote Agile, DevSecOps, quality engineering, and AI-assisted delivery practices
• Ensure governance, planning, risk management, and performance reporting for technology initiatives
• Maintain platform health, resiliency, security, compliance, and scalability
• Ensure solutions support reliability, interoperability, scalability, and long-term sustainability
• Manage technology investments, budgets, and resource allocation
• Build internal engineering capabilities and strategically apply vendors and partners
• Institutionalize critical knowledge, intellectual property, and operational ownership
• Build, lead, and develop high-performing technology teams
• Foster engineering excellence, collaboration, inclusion, and customer-centricity

Care Manager, Telephonic Behavioral Health

Senior Technology Leadership

Bilingual Field Care Coordinator

Field Care Coordinator – Bilingual Preferred

Associate VP, Services Procurement

Care Management Support Assistant

Director, Product Management

Grievances & Appeals Representative

Care Management Support Assistant

Licensed Practical Nurse

Associate Director, Applied AI

Actuarial Analyst

Actuarial Analyst

AVP, Quality Engineering – CenterWell Segment

Director, Technology Solutions – Provider Solutions Engineering