Jobs at Humana

Develop and maintain long-term relationships with physicians, providers, and health systems to improve financial and quality performance. Advise leadership on strategies, manage projects related to incentive programs, HEDIS/STARs, population health, data sharing, coding, and operational improvements. Use independent judgment on complex issues and support member and provider experience.

Lead analytics projects using advanced and predictive modeling to optimize programs, forecast behavior, and drive revenue. Partner consultatively with business, IT, and SMEs across project lifecycle—intake through delivery—communicating results to stakeholders and senior leadership. Work independently on complex technical approaches and influence department strategy.

Provide comprehensive case management for frail elders and adults with disabilities: assess needs, develop and update Member Care Plans, coordinate services with nursing and community resources, perform face-to-face assessments and quarterly visits, maintain documentation, and ensure cost-effective, safe care.

Performs medical necessity and comprehensive medication reviews for pre-authorizations, analyzes medication care plans and utilization patterns, advises patients/providers to promote cost-effective, quality outcomes, and follows established utilization management guidelines.

Design and deploy responsible generative AI solutions using LLMs and agentic AI frameworks. Collaborate with MLOps/DevOps, engineers, and business partners to integrate scalable, reliable models into enterprise workflows, build monitoring and ETL pipelines, and communicate results to stakeholders.

Manages provider data (demographics, rates, contract intent), provider audits, credentialing, contract management systems, and provider relations. Oversees intake and resolution of provider service failures, coordinates vendors and administrative work groups, prioritizes daily activities, and executes mid-to-large scale project tasks with broad guidelines and minimal oversight.

The UMAC provides non-clinical support in a remote setting, managing chart reviews, authorizations, and member engagements while collaborating across departments.

Lead and mentor a team of solution and systems architects to design scalable, secure cloud-native digital platforms and personalized AI/ML experiences. Drive platform strategy, reusable design patterns, DevSecOps automation, multi-cloud adoption, MACH-based front-end and microservices architectures, vendor integrations, governance, and enterprise architecture alignment to improve developer experience and customer digital interactions.

Review utilization management documentation to ensure policy, procedural, and regulatory compliance. Process QIO fast-track appeals and expedited authorization requests, collect and analyze operational metrics, make independent determinations within guidelines, and support continuous improvement of consumer experiences while protecting member PHI in a remote home-office environment.

Analyze and forecast financial, economic, and market data to support strategic and operational decisions. Establish metrics, ensure data integrity, perform root cause analysis, develop forecasts, collaborate with stakeholders, and advise executives on functional strategies across short-, medium-, and long-term planning.

Lead cross-functional product initiatives for clinical care management and enterprise technology. Define priorities, translate business needs into scalable solutions, coordinate workstreams, manage risks, support adoption, and deliver measurable outcomes with Agile teams.

Lead cross-functional analytics and informatics projects from problem definition through implementation and measurement. Translate ambiguous business questions into structured analytical approaches, synthesize diverse healthcare data, build decision-support tools, and communicate evidence-based recommendations to stakeholders and senior leaders to influence strategy and operational priorities.

Provide executive legal support by managing complex calendars, travel, and expense reports; prepare, proofread, and format contracts and documents; maintain physical and electronic files and track legal invoices and budgets; serve as liaison to executives, internal teams, and external counsel while protecting confidential information.

Lead and manage Medicare Stars gap-closure initiatives across Florida. Conduct medical record reviews, support EMR-based provider gap closure, perform member outreach, engage providers (in-person/virtual), educate on HEDIS, and partner with internal teams and vendors to improve quality and documentation.

Lead BI efforts by collecting, integrating, analyzing, and visualizing complex internal and external data. Advise executives and develop functional strategies, translate requirements across business and technical teams, lead projects, present insights to senior leadership, and build analytics solutions using tools like Power BI, Adobe Analytics, and Databricks.

Reviews utilization management activities and documentation to ensure policy and regulatory compliance, detect fraud/waste/abuse, and process QIO appeals and expedited authorizations. Collects and analyzes outcome and operational metrics, exercises independent judgment on complex cases, and works remotely on a four-day, 10-hour shift (Wed–Sat or Thu–Sun) within EST. Requires strong telephonic/virtual communication and home office internet/HP A protections.

Design, build, and maintain scalable data processing architectures and ETL pipelines. Develop and maintain SQL stored procedures and Python automation, ensure data quality and performance, participate in code reviews and testing, and collaborate with stakeholders to solve ambiguous business problems.

Lead enterprise Anaplan architecture and integrations for Finance and HR. Design models, governance, security, and integrations with systems (Workday, SAP, Oracle, Snowflake). Mentor architects, manage ALM, build reporting (Power BI/Tableau), drive platform strategy, ensure data governance and compliance, and support adoption across stakeholders.

Analyze large pharmacy, Medicaid, and Medicare datasets to produce actionable insights. Build and maintain dashboards and visualizations, investigate trends and root causes, recommend process improvements, partner with cross-functional teams, ensure data integrity, and influence strategy through data-driven recommendations to improve pharmacy operations and member experience.

Lead the digital product vision and roadmap for mobile-first and responsive experiences. Lead discovery, prioritize investments using analytics and customer insights, drive platform capability evolution, partner cross-functionally with Design, Engineering, Operations and Analytics, and manage delivery, documentation, and success metrics across multiple workstreams.