Humana

Designer

• Uses instructional design, cognitive psychology, and adult learning theory to determine appropriate solutions
• Analyzes learning and performance needs, organizes content, designs solutions
• Writes facilitator guides, storyboards, scripts, training manuals
• Develops multi-modal learning material, including instructor-led and self-paced training
• Tracks and analyzes training programs' effectiveness

Learning Design Professional

• uses instructional design, cognitive psychology, and adult learning theory to determine appropriate solutions to knowledge or performance gaps
• analyze needs, organize content, design solutions, write facilitator guides, storyboards, scripts, performance support resources, mobile learning solutions and manuals
• conduct need analysis with clients to determine learning solutions
• write learning objectives and coordinate performance assessments
• develop multi-modal learning material, including instructor-led and self-paced training
• provide instruction and guidance to Learning Facilitators
• track and analyze training programs effectiveness

Senior Learning Design Professional

Financial Planning and Analysis

• The Senior Financial Analytics Professional manages data to support and influence decisions on day-to-day operations, strategic planning and specific business performance issues.
• The Senior Financial Analytics Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
• This position utilizes financial modeling of operational revenues and analytics skills while working in Medicare risk adjustment.
• Additionally, you will work to build consensus with multiple stakeholders and deliver insights that will help program managers meet operational needs in a dynamic environment.
• The MRA finance team within Quality & Cost Strategy (QCS) is responsible for projecting and tracking risk adjustable revenue.
• Specifically, this role projects and tracks risk adjustable revenue from prospective programs and other strategic initiatives to inform the overall revenue forecast.
• Claims data as well as data from CMS are utilized to project revenue generated from specific programs.
• The primary tools used in this position to validate and analyze data are SQL and Excel pivots.
• The Senior Financial Analytics Professional collates, models, interprets and analyzes data to identify, explain, and influence variables and trends.
• Enhances modeling techniques. May possess financial or actuarial background. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components.

Senior Financial Analytics Professional

Business Intelligence Analyst

• Lead a team of Senior and Professional level Business Intelligence Engineers through the various stages of inquiry resolution to include root cause analysis, impacts, action planning and execution
• Analyze Medicaid data to solve a wide variety of business problems and create data visualizations that drive strategic direction utilizing healthcare and other related data, provide clear and concise analysis and recommendations to senior leadership

Manager, Business Intelligence

Sales

• Provide support to the Sales team throughout the sales cycle
• Collect and organize RFP info (census, claims, RAF, etc.) and track down missing information from Broker/Client Support sold groups in the implementation process
• Collect required materials for Account Installation
• Submit all sold paperwork to Implementation
• Complete LMG system updates (Launch my Group (LMG)
• Attend Implementation call
• Partner with and provide support to brokers as they navigate Humana
• Answer general benefit questions and respond to brokers with marketing flyers
• Partner with internal stakeholders such as marketing, product, actuarial, underwriting, account installation and service
• Creation and Distribution of scheduled market communication
• Agent bonus tracking and organization
• Maintain a strong connection with internal market team members, collaborate to achieve results and solutions

Sales Support Professional

Medical Director

• Use clinical expertise, medical judgment, and experience to determine authorization for requested services, level of care, and site of service.
• Perform medical necessity reviews in compliance with regulatory standards, CMS requirements, Humana policies, clinical guidelines, and applicable contractual obligations.
• Apply knowledge of Medicare and Medicare Advantage requirements in daily utilization management and coverage determination activities.
• Conduct computer-based review of moderately complex to complex clinical cases, primarily involving inpatient and post-acute care scenarios.
• Review all submitted clinical documentation and records to support accurate, evidence-based determinations.
• Interpret whether services rendered by other healthcare professionals align with national guidelines, clinical standards, CMS requirements, and internal policies.
• Prioritize daily case review workload to ensure timely completion and adherence to compliance-driven turnaround times.
• Communicate utilization review decisions and clinical determinations to internal associates and relevant stakeholders.
• Speak regularly with external physicians to obtain additional clinical information, discuss determinations, and support peer-to-peer review processes.
• Use conflict resolution skills when needed during physician discussions related to adverse determinations or clinical review outcomes.
• Participate in care management activities when applicable to support quality, coordination, and appropriate resource utilization.
• Provide oversight or input, as applicable, regarding coding practices, clinical documentation, grievance and appeals processes, and outpatient services and equipment reviews.
• Collaborate with internal team members, cross-functional departments, Humana colleagues, and regional health services leadership to support organizational and market goals.
• Engage with contracted physicians, physician groups, facilities, and community organizations to support regional priorities and strengthen collaborative business relationships.
• Contribute to initiatives related to value-based care, population health, disease management, and care management strategies.
• Work effectively in a structured environment with strong expectations for consistency in clinical reasoning, written determinations, and documentation.
• Perform daily responsibilities independently after mentored training, exercising sound judgment with minimal direction.
• Meet departmental expectations for quality, consistency, productivity, and compliance timelines.

Medical Director – OP Medicare

Risk

• Identify and investigate potential sources of clinical and operational loss
• Report to the Associate Director and focus on complex issues requiring in-depth evaluation
• Analyze and manage clinical occurrence reports and patient safety-related concerns
• Identify trends and system vulnerabilities affecting patient or staff safety
• Work with clinical, compliance, legal, and operational partners to mitigate risk

Senior Clinical Risk Management Professional

Project Manager

• Ensure the successful execution of complex initiatives
• Oversee program and project management from initiation to closure
• Handle multiple concurrent initiatives encompassing operations, compliance, quality, and member experience
• Design, communicate, and implement comprehensive operational plans for Medicare and Duals-related programs and projects
• Lead multiple complex initiatives simultaneously
• Collaborate with stakeholders across cross-functional teams
• Monitor project progress and performance, proactively identifying and resolving issues
• Develop program and project schedules, budgets, forecasts, and work specifications
• Coordinate internal and external resources, including vendors and contractors
• Facilitate cross-program communication with leaders to manage interdependencies
• Conduct regular status meetings and prepare executive-level reports

Lead Project Manager

Procurement

• works as liaison between vendors and organization
• reviews and negotiates terms of vendor contracts
• communicates with vendors regarding daily matters
• develop positive relationship with vendors
• monitor vendor performance
• research invoice and contractual issues
• resolve discrepancies
• influence department's strategy
• make decisions on moderately complex to complex issues regarding technical approach for project components
• perform work without direction
• exercise considerable latitude in determining goals and approaches to assignments

Vendor Management Professional

Growth Marketing

• Conducting analysis and/or work streams within high-profile, high-impact strategy projects
• Participating in interviews and working sessions with leaders within Medicare and Medicaid and across the broader organization
• Conducting industry, market, competitor, and financial analysis and identifying insights for Humana
• Creating high quality analysis and deliverables that clearly frame objectives, issues, and challenges, and articulate insightful findings and recommendations
• Working collaboratively with fellow team members and leaders across the company

Growth Strategy Consultant

Manager

• Support the coordination, documentation, and communication of medical services and/or benefit administration determinations.
• Apply advanced technical knowledge to solve moderately complex problems.
• Coordinate and communicate with providers, members, or other parties to facilitate optimal care and treatment.
• Conduct briefings and area meetings; maintain frequent contact with other managers across the department.

Manager, Utilization Management – Behavioral Health

Recruitment

• Support the development and execution of a comprehensive campus recruiting strategy for Technology roles, ensuring alignment with Humana's overall hiring goals and business needs.
• Manage and facilitate recruiting activities on-campus and virtually across 15-20 target schools including networking events, executive speakers, information sessions, club events, and other events to attract a high caliber and quantity of applicants.
• Build and nurture strong relationships with key university career centers, professors, student organizations, tech clubs, and other academic partners to establish Humana as a top employer for IT and technology talent.
• Represent Humana at career fairs, networking/club events, and information sessions.
• Source, engage, and recruit high-potential candidates for internships and entry-level technology positions across multiple technical disciplines, including software engineering, data science, IT infrastructure, cybersecurity and more.
• Lead campus initiatives and create engaging recruitment marketing materials, presentations and post-event follow up emails to attract talent.
• Screen resumes, send HireVue assessments, and manage top of funnel candidate activity.
• Track and report on recruiting metrics, providing regular updates on recruiting progress, challenges, and successes.
• Use market knowledge to advise hiring managers on potential bottlenecks and develop a strategy to influence the candidates' decision to join.
• Measure the campus recruiting program's successes and growth opportunities through internal data.

Campus Recruiter – Technology

• perform telephonic and face-to-face assessments and evaluations of the needs and requirements of our long-term services and support (LTSS) and aged, blind and disabled (ABD) member population
• support achieving and/or maintaining optimal wellness by guiding members/families toward and facilitating interaction with resources
• work assignments that are varied and frequently require interpretation and independent determination of the appropriate courses of action
• meet members in the field at their home or location of the member's choice, spending quality time assessing their goals, needs and barriers
• connect our members with quality services to promote their ultimate well-being and drive person-centered health outcomes
• review and analyze for medical complexity
• develop member individualized care plans
• employ a variety of evidence-based strategies and techniques to manage a member's physical, environmental, and psychosocial health
• identify and resolve barriers that hinder effective care
• ensure member is progressing towards desired outcomes by continuously monitoring member care through comprehensive assessments and/or evaluations
• make autonomous decisions, occasionally in ambiguous situations
• require minimal direction and receive guidance where needed
• understand department, segment, and organizational strategy and operating goals, including their linkages to related areas
• follow established guidelines/procedures.

RN, Field Care Manager

Product Manager

• Serve as the Director’s primary partner in shaping and advancing the strategy and roadmap for the Humana Spending Account Card
• Translate strategic direction into clear execution plans, workstreams, and cross‑functional deliverables
• Develop analyses, options, and recommendations to inform leadership decision‑making
• Lead execution of benefit design and structural changes aligned to CMS regulations and business goals
• Oversee benefit configuration, system setup, testing coordination, and quality assurance
• Provide subject‑matter expertise on regulatory requirements and implementation best practices
• Identify opportunities to improve member experience, operational efficiency, and benefit clarity
• Drive continuous improvement initiatives using performance data and stakeholder feedback
• Partner with the Director on vendor management for card processing and benefit administration
• Act as a trusted point of contact for cross‑functional Spending Account Card initiatives
• Manage multiple concurrent, high‑visibility initiatives effectively

Principal, Insurance Product Management – Supplemental Benefits Operations

• Gather, analyze, and document business and functional requirements for technology solutions.
• Influence and support system design to ensure alignment with business needs and optimal supportability.
• Collaborate closely with Finance, IT, and Service Fund teams throughout the project lifecycle.
• Lead and coordinate implementation activities, including testing, operational readiness, and handoff to production support.
• Apply strong accounting and financial understanding to project work.
• Facilitate cross-functional collaboration and maintain strong working relationships with all key stakeholders.
• Provide project leadership and guidance to ensure timely and successful delivery of initiatives.