Humana

Medical Director

• Uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, or requested site of service should be authorized, with all work occurring within a context of regulatory compliance and assisted by diverse resources, which may include national clinical guidelines, state policies, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other reference sources
• Learns Medicaid requirements and understands how to operationalize this knowledge in their daily work in their assigned cluster
• Work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management, with clinical scenarios arising from outpatient or inpatient environments
• Conducts discussions with external physicians by phone to gather additional clinical information or discuss determinations through the peer-to-peer process, and in some instances, these may require conflict resolution skills
• May speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes and a focus on collaborative business relationships, value-based care, population health, or disease or care management
• Supports Humana values including working collaboratively on a team throughout all activities
• Flows to work as needed within cluster as needed for vacations, weekends and holidays coverage

Behavioral Health Medical Director

Business Intelligence Developer

• Convert processes requiring manual steps (many in Excel) to a more effective tech stack.
• Optimize Pricing Model SQL code where there are known performance issues.
• Triage data/code/user error issues and resolve quickly and effectively.
• Design, demo, develop and test new more efficient processes, typically that are short term/high impact projects.
• Effectively communicate technical concepts to a broad range of audiences including customers, business partners and IT.
• Work closely with the business team, customers and IT to collaborate on technical solutions.
• Coordinate with other developers (both business and IT) to ensure dependencies are documented and testing is sufficient for monthly releases.

Business Intelligence Engineer – Entry Level

Compliance

• Participate in performance and quality improvement projects by implementing member and provider targeted interventions to improve health outcomes and member and provider experiences.
• Contribute to multidisciplinary committees, both external and internal, required by NCQA and the State Contract.
• Medical record audits to evaluate provider compliance with clinical practice guidelines, best practices, and regulations in collaboration with internal and external stakeholders.
• Provider outreach to close care gaps.
• Completing and updating reports (including State Reports and Kentucky Medicaid Quality Improvement Committee reports).

Quality Compliance Professional

• Lead and manage all disaster recovery compliance efforts, including data management, governance, and regulatory reporting.
• Oversee internal and external audit response activities, ensuring readiness for Medicare/Medicaid and other regulatory audits.
• Manage IT controls and coordinate RFP responses for disaster recovery requirements.
• Conduct annual DR audits of SaaS providers, ensuring vendors meet recovery and resiliency objectives and reporting on any gaps.
• Drive vendor due diligence for new and renewing contracts, ensuring appropriate recovery-focused language is included and enforced.
• Partner with Business Continuity leaders to mature business capability mapping and strengthen process-to-application mapping and dependency analysis.
• Administer, manage, and develop the ServiceNow Disaster Recovery module, ensuring its functionality aligns with program goals.
• Oversee program training initiatives and documentation management to ensure all stakeholders are educated and compliance standards are maintained.
• Provide DR compliance reporting and insights to senior leadership.
• Support inclusion in vendor testing to verify recovery objectives and enhance audit responses using robust compliance data.
• Maintain awareness of changing regulatory requirements and industry best practices.
• Partner and align on all merger & acquisition activities for smooth onboarding and transition to Humana's DR program.

Associate Director, IT Disaster Recovery – GRC

Insurance

• partners closely with business, technology, and product stakeholders across the Insurance value chain to ensure the IT portfolio and demand pipeline are aligned to enterprise priorities
• organizes and prioritizes programs and projects in alignment with IT Strategy, Enterprise Architecture guidelines, Delivery roadmaps, and segment‑level strategic plans
• balancing discretionary and non‑discretionary spend (e.g., regulatory, compliance, security, member experience, operational efficiency)
• evaluating funding against annual portfolio budgets
• managing intake/throughput capacity
• adjusting schedules
• ensuring the right financial and organizational support is allocated to priority work
• begins to influence departmental strategy and drives technology portfolio decisions by evaluating business value, platform impacts, customer experience outcomes, and risk
• exercises considerable latitude in determining objectives, methodologies, and approaches to assignments.

Senior IT Portfolio Management Professional – Insurance Tech Segment

Consultant

• Work with SouthEast Region providers to define and advance their goals related to interoperability, quality, value-based arrangements, and risk adjustment strategies
• Recommend execution strategies and monitor performance toward these goals
• Actively monitor and analyze provider performance data to identify areas for improvement
• Be an expert on the Stars/Quality program, educating physician groups on HEDIS, patient safety, and patient experience
• Collaborate to develop tailored action plans and communicate applicable insights to improve performance
• Implement strategies to enhance outcomes and provide ongoing support and guidance to providers
• Be a liaison for providers to access Humana resources, educating and encouraging providers on the use of self-serve tools
• Educate provider groups on reward programs and target metrics, collaborating to achieve established goals
• Monitor and reports on the effectiveness of reward programs, making recommendations for enhancements
• Resolve provider abrasion issues, ensuring a positive and collaborative relationship between Humana and its providers
• Collaborate with teams to drive initiatives that support provider performance improvement

Senior Network Performance Consultant

Manager

• Lead teams of nurses, care coordinators and behavioral health professionals responsible for care management
• Supervise, direct and evaluate a diverse group of health care professionals
• Identify members for specific case management and/or disease management activities
• Monitor case management activities, post-discharge calls, discharge planning and pre-assessment of elective admissions
• Develop system-view recommendations, reports trends and implement appropriate actions to control trends
• Develop audit plans and tools for teams to ensure compliance with state contracts on performance metrics
• Onboard new associates including all pre-employment human resource tasks, ordering software, hardware, supplies and support technologies
• Monitor performance of staff including service performance and adherence to established utilization and care coordination benchmarks
• Conduct care team oversight visits, meeting with members and/or their families, community partners and other care teams

Manager, Care Management

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RN, Field Care Manager – Adults and Pediatrics

Full-stack Engineer

• Standardizes the quality assurance procedure for software
• Oversees testing and debugging and develops fixes
• Researches complaints and makes necessary adjustments and/or recommendations to resolve complex software related issues
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas
• Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed
• Follows established guidelines/procedures
• Provides on-call support as scheduled

Senior Software Engineer

Solutions Engineer

• Own the end-to-end Anaplan solution architecture across Workforce Planning and Workforce Management domains
• Operates at a strategic level, responsible for setting the overall architectural vision and standards for Anaplan across the organization.
• Serves as the subject matter expert and key advisor for complex, enterprise-wide Anaplan implementations and integrations.
• Subject matter expert in modeling frameworks, governance, and best practices, mentoring Lead Architects and other team members.
• Engages in strategic planning, platform optimization, and alignment with broader enterprise architecture initiatives.
• Lead the design and implementation of Anaplan modules for: Finance : Headcount cost modeling, compensation planning, forecasting, scenario analysis. HR : Position management, hiring plans, attrition modeling, workforce analytics.
• Oversee Architects and maintain integration strategies with enterprise systems (e.g., Workday, SAP, Oracle, Snowflake) and ensure seamless data flow across platforms.
• Subject matter expert on Anaplan security models, user roles, and access controls across domains.
• Lead and mentor offshore and cross-functional teams in model development, testing, and deployment.
• Establish, develop and maintain reporting and dashboard solutions using Anaplan and complementary tools (e.g., Power BI, Tableau).
• Serve as a strategic SME to Finance and HR leadership, helping shape the enterprise planning roadmap.
• Act as a cross-functional bridge between IT, Finance, and HR, ensuring alignment of planning tools with business strategy.
• Contribute to the enterprise technology roadmap by evaluating emerging trends in workforce planning, predictive analytics, and EPM platforms.
• Promote continuous improvement by identifying inefficiencies, proposing enhancements, and driving innovation across planning processes.
• Ensure compliance with data privacy, security, and governance standards (e.g., GDPR, HIPAA, SOX).
• Lead management efforts to drive adoption of new planning capabilities and tools.

Principal Anaplan Solution Architect

Medical Billing and Coding

• Identify opportunities to improve provider documentation and create education plans tailored to each assigned provider
• Arrange educational sessions with assigned providers aimed at quality of care and documentation improvements
• Pull MRA reports, identify educational needs based on reports, and present information
• Use data analytics tools to assess coding quality, identify error patterns, and monitor compliance with internal and external standards
• Participate in teams to improve documentation, data integrity, and workflow processes
• Build ongoing relationships with staff and providers teams
• Conduct virtual education and/or provider onsite education, based on business needs
• Collaborate with other market provider facing roles

Medical Coding Educator

Program Manager

• Provide strategic leadership and oversight for the prioritization, planning, and execution of high-impact, enterprise-wide growth initiatives.
• Serve as the principal architect for large-scale Medicare Advantage strategy initiatives, guiding the end-to-end lifecycle from strategy development through implementation and value realization.
• Engage with executive leadership to frame and address complex challenges, leveraging advanced analytics, market intelligence, and financial modeling to inform strategic decision-making.
• Lead strategic integration efforts, ensuring cohesive alignment of growth initiatives across multiple business units and corporate functions.
• Develop and deliver executive-level presentations, reports, and recommendations that articulate strategic priorities, operating context, and actionable insights for senior stakeholders.
• Establish and own infrastructure and processes to monitor progress against enterprise strategic objectives, proactively identifying risks and implementing mitigation plans.
• Champion talent development and mentorship, cultivating a high-performing, diverse team and supporting professional growth for junior staff.
• Foster a culture of innovation, collaboration, and continuous improvement throughout the Growth organization.

Growth Strategy Director – Strategic Program Management

• Conducts telephonic and in-person assessments to evaluate members’ needs, guiding members and their families toward appropriate resources to support optimal wellness.
• Continuously monitors member progress through ongoing assessments and evaluations to ensure achievement of desired health outcomes.
• Develops individualized care plans based on comprehensive assessments, aligning with departmental and organizational strategies.
• Collaborates with healthcare providers and community resources to facilitate quality, cost-effective care and support.
• Ensures members receive necessary services and supports across Behavioral Health, Physical Health, Social Determinants of Health, and value-added benefits.
• Coordinates with the transdisciplinary care team, including at minimum the Primary Care Provider (PCP), to manage transitions of care.
• Documents and submits incident reports as required.

Field Care Manager, Behavioral Health

Vice President

• manage the development, operations, and results of a health plan
• establish long-range goals, objectives, and plans
• monitor financial and operational performance
• coordinate activities of senior managers and their respective functions
• represent the health plan externally and to governmental/external agencies
• develop and implement strategic plans for the scope of management that are aligned with the Segment or Business strategy

Regional VP – Provider Contracting

• Perform software engineering activities in all layers of the stack
• Lead technical architecture and design and present vision
• Possess the ability to evaluate problems in both strategic and tactical terms
• Lead a small team of high-caliber engineers by mentoring and coaching
• Deliver business-critical systems and components with high quality and on time
• Review pull requests and provide constructive feedback
• Investigate and propose new ideas, frameworks technologies, or processes