Humana

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.
• Maintain ongoing communication with departmental managers to ensure alignment and operational efficiency.
• Develop audit plans and tools for teams to ensure compliance with state contracts on performance metrics.
• Interview, hire, mentor, evaluate, coach and manage performance for a diverse care coordination team.

Manager, Care Management

Procurement

• Oversee vendor management operations from a market perspective
• Direct a team of RN professionals
• Foster effective vendor and provider relationships
• Drive resolution of clinical and operational issues to support quality care and compliance
• Provide strategic leadership and guidance to the Senior Vendor Management Professional (RN) team
• Oversee and optimize vendor relationships, including performance monitoring and compliance management
• Facilitate collaboration between Humana, vendor partners, and providers
• Support the review of clinical authorizations and ensure consistency with established guidelines
• Identify systemic gaps and process improvement opportunities across vendor partnerships
• Analyze market trends, operational data, and vendor performance metrics
• Ensure adherence to privacy, security, and enterprise information protection protocols
• Mentor and develop team members
• Participate in strategic planning, vendor selection, and contract negotiations

Vendor Management Lead

Vice President

• Develop and lead national provider network strategy across Medicare and Medicaid segments
• Strategic Partner with all segments of Humana's Insurance Business
• Ensure adequate coverage of primary care, specialty and ancillary services
• Align strategy and priority between different segments/functions
• Establish enterprise wide contracting standards, best practices and policies for Medicare and Medicaid lines of business
• Lead Enterprise change efforts regarding contract standardization
• Ensure access to care for members, network adequacy and gap closure
• Develop and lead trend initiatives with key providers and partners
• Executive leadership of Provider Performance and Analytics functions

VP, National Provider Network Management

General Counsel

• Providing legal advice and support for Humana's Medicare Advantage lines of business
• Providing legal support for delegate contracting, including drafting, reviewing, and advising on agreements with delegated entities
• Advising on CMS provider credentialing, and eligibility requirements
• Providing legal support for provider quality investigations and Humana Peer Review Committee activities
• Supporting Medicare product development and operations, including benefit design and administration, licensure, bid development, and product filings
• Collaborating and consulting with leaders throughout the company

Counsel – Medicare Advantage

Actuary

• setting pricing assumptions, submitting bids, filing and gaining approval of premium rates and rate certifications with regulatory agencies
• supports implementation of rates, new plans and benefit changes
• provides guidance to Product Development on new product/benefit cost impacts
• develops and maintains pricing tools that price standard and custom benefits
• establishes market level financial metrics to align with segment profitability goals
• analyzes market level results and projections and develops recommended pricing actions to address gaps to targeted metrics
• leverages market level projections and experience data tools to research root cause and capture insights
• researches and understands competitors in marketplace and collaborates with sales and other partners supporting the markets to develop strategies for profitable membership growth
• accountable for actuarial certifications on rate filings, including attesting to compliance with state and federal rating and benefit regulations
• begins to influence department’s strategy
• makes decisions on moderately complex to complex issues regarding technical approach for project components

Associate Actuary, Pricing

• Assess and evaluate member's needs to achieve optimal wellness
• Identify and resolve barriers to effective care
• Communicate with internal and external stakeholders
• Create plans of care and monitor patient progress
• Conduct home visits for Medicaid members (75-90% travel)

Field Care Manager – RN

Security Engineer

• Serve as primary AI Security SME for the Cyber Security organization.
• Serve as the AI Security SME for major enterprise projects, providing expert guidance on AI security architecture, policies, and standards.
• Develop, refine, and govern the AI Security Capability Framework across the enterprise.
• Establish reference architectures and guardrails for first‑party LLMs, Azure OpenAI, Microsoft/GitHub Copilot, and third‑party AI features in SaaS platforms.
• Integrate AI security controls and requirements into enterprise architecture patterns and overlays.
• Lead the evaluation, selection, and implementation of AI security tools.
• Stay current with advancements in AI/ML security, threat landscapes, and emerging technologies.
• Participate in and support audits, compliance reviews, and incident response.
• Partner to develop and enforce AI security policies.
• Perform AI threat modeling and risk assessments to identify, prioritize, and mitigate security risks.
• Collaborate with enterprise architects, engineering, DevOps, and security teams to ensure alignment of AI security practices.
• Mentor and provide technical guidance to security engineers and project teams regarding AI security best practices.
• Create playbooks for AI-specific incident response, conduct tabletop exercises, and lead post-incident forensics and hardening.

Principal AI Security Architect

• assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state
• guides members and families toward resources appropriate for the care and well-being of members
• Identifies and resolves barriers that hinder effective care
• Ensures member is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations
• Create plans of care
• Communicates with internal and external stakeholders
• 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), requires minimal direction, and receives guidance where needed
• Follows established guidelines/procedures
• Visits Medicaid members in their homes, Supportive Living Facilities, and/or Long-Term Care Facilities and other care settings – 75-90% local travel

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Lead Software Engineer – Next Best Action

Solutions Engineer

• Define and maintain the end-to-end NBA platform architecture, encompassing data ingestion, state management, decisioning, business rules, machine learning, and channel activation.
• Serve as the technical authority across NBA domains, including State Machine, Action Library, Decision Engine, Data and ML Platforms, and Channel & Integration Services.
• Establish and uphold architectural standards for API-first, event-driven, cloud-native solutions, ensuring consistency across teams and external partners.
• Review and approve solution designs, major technical decisions, and non-functional requirements related to scalability, resiliency, performance, and security.
• Ensure explainability, auditability, and governance are embedded in decisioning workflows, with a focus on regulated use cases.

Principal Solutions Architect

Product Manager

• Serve as the primary administrator for Sales Enablement Library materials within HighSpot
• Establish and maintain content governance standards
• Ensure platform configuration supports business needs
• Manage key relationships with business partners to align platform execution to business outcomes
• Act as the central point of coordination between stakeholders to prioritize requests
• Train and coach content owners on platform capabilities and best practices
• Partner with content strategists and creative vendors to plan promotion and placement of content on HighSpot
• Collaborate with the MarketPoint training team to ensure consistent branding and shared architecture principles

Senior Product Owner

• Perform primarily face to face and telephonic assessments with members
• Serve as the primary point of contact providing integrated care
• Utilize high-quality, evidence-based behavioral health services through personalized care coordination
• Provide comprehensive, integrated support to members experiencing behavioral health conditions
• Engage members in their own communities, meeting face-to-face whenever possible
• Complete all required assessments, including the Comprehensive Risk Assessment (HRA)
• Coordinate behavioral health and medical services
• Improve member's health literacy while addressing health-related social needs
• Serve as the quarterback of the member's interdisciplinary care team (ICT)
• Facilitate ICT meetings, ensuring seamless communication among providers
• Proactively support transition of care efforts
• Collaborate with internal departments, providers, and community-based organizations

Field Care Manager, Behavioral Health

Machine Learning Engineer

• architect, develop, and manage machine learning systems that enable real-time, personalized decision-making across digital and assisted channels.
• lead the creation of ML pipelines, online inference services, and decision-time scoring logic.
• design and manage end-to-end machine learning systems, including: Feature engineering and reuse strategies, Offline training pipelines, Online inference and scoring services.
• ensure systems meet stringent requirements for latency, scalability, reliability, and correctness in real-time contexts.
• build and operationalize models such as propensity or likelihood prediction, uplift or incremental impact models, engagement or responsiveness scoring.
• collaborate with analytics and product teams to translate business objectives into measurable modeling outcomes.

Lead Machine Learning Engineer – Next Best Action Platform

• Run high-fidelity threat-actor and control-validation campaigns, maintain agent health, convert raw BAS platform test results into actionable findings, and track them in the enterprise risk management platform
• Leverage offensive security expertise to determine the effective approach for executing simulations and manage multiple projects simultaneously
• Review the latest products from the Threat Intelligence team on a specific threat actor, chaining custom Tactics, Techniques, and Procedures (TTPs) for a Threat Simulation, and developing complementary custom test cases using the platform’s Python API
• Initiate a bi-weekly Security Baseline, collaborate with SIEM Engineering to tune detection logic after analyzing recent baseline results, write concise findings for documentation in the enterprise risk management system, and conduct in-depth analysis of IOC Validation gaps
• Propose enhancements to security countermeasures and suggest new service-line use cases to the Lead for roadmap consideration

Senior Engineer, Offensive Security

• Lead a small, high-performing team responsible for cyber countermeasure readiness.
• Develop and maintain a strategic roadmap for cyber countermeasure tooling.
• Ensure all countermeasure tools are continuously evaluated against current and emerging threat intelligence.
• Establish and maintain a prioritized book of work for countermeasure enhancements.
• Partner with countermeasure delivery teams to prioritize work and investment to maximize countermeasure readiness.
• Define and implement metrics and monitoring strategies to measure effectiveness and readiness.
• Collaborate with threat intelligence, incident response, and security operations teams to ensure alignment and integration.
• Collaborate with Offensive Security to create and execute regular validation testing.
• Drive continuous improvement of countermeasure capabilities to maximize disruption of cyber threats.
• Provide executive-level reporting on countermeasure strategy, progress, and effectiveness.

Manager, Care Management

Vendor Management Lead

VP, National Provider Network Management

Counsel – Medicare Advantage

Associate Actuary, Pricing

Field Care Manager – RN

Principal AI Security Architect

Field Care Manager – RN

Lead Software Engineer – Next Best Action

Principal Solutions Architect

Senior Product Owner

Field Care Manager, Behavioral Health

Lead Machine Learning Engineer – Next Best Action Platform

Senior Engineer, Offensive Security

Director, Cyber Security Countermeasures