Search the 69 jobs at Humana

As a Senior TBM Analyst, you will develop and maintain the TBM cost and data model in Apptio, collaborate with cross-functional teams, analyze financial and technology data, and drive cost accountability within the organization. The role involves providing insights into IT cost and identifying process improvement opportunities while ensuring data governance.

The Acquisition Integration Advisor manages the integration of acquired entities through mergers and separations. Responsibilities include leading Integration Management Offices, collaborating with leadership for strategic alignment, planning execution, advising on value capture and risk management, and working with minimal supervision on complex issues.

As a Case Manager, you will support members of the Wisconsin Family Care program, providing assistance with daily living, conducting assessments, coordinating care plans, and fostering community integration for vulnerable populations, including frail elders and adults with disabilities. The role involves regular travel for face-to-face visits and phone contacts with members.

As a Case Manager, you'll provide comprehensive social service care management to elderly and disabled members in the Wisconsin Family Care program. Your responsibilities include assessing member needs, coordinating care plans, supporting community integration, and documenting activities. You'll work collaboratively with health professionals and may need to travel to provide services in members' homes.

The Value-Based Programs Lead manages value-based provider relationships to enhance provider experience and achieve path-to-value objectives. Responsibilities include developing innovative value-based program models, analyzing financial and performance data, and collaborating with teams for operational rollout. They also monitor performance metrics and refine model designs based on feedback.

The UM Coordinator is responsible for managing prior authorization requests, assisting providers and members with authorization processes, and ensuring compliance with medical necessity standards. The role involves taking inbound calls, handling inquiries, documenting information, and navigating multiple systems in a fast-paced environment.

The Value-Based Contracting Lead ensures effective development and translation of Medicaid VBP models into contracts and educational materials. This role involves managing negotiation processes, collaborating with cross-functional teams, and serving as a subject matter expert in VBP contracting, ensuring compliance and operational effectiveness.

The Software Engineer develops and tests software applications, ensuring quality assurance standards are met. Responsibilities include debugging, upgrading frameworks, integrating security measures, and contributing to code reviews within an Agile environment.

As a Strategy Advancement Advisor, you will create and align IT strategies with business needs, deliver executive presentations, engage with technology leaders, and coach team members. You will work to enhance consumer experiences and stay updated on emerging technologies within the healthcare sector.

The Case Manager will provide comprehensive social service care management for members of the Wisconsin Family Care program, performing assessments and coordinating care plans. Responsibilities include regular visits to members, educating on wellness, and collaborating with a Health and Wellness Coordinator, with 40% of the role involving travel to meet members in their homes.

The Transition Coordinator evaluates members' needs, assists in planning and follow-up care during transitions, and ensures continuity in Medicaid programs. They guide members towards appropriate resources and coordinate care with healthcare professionals to maintain optimal well-being.

The Functional Screen Specialist assesses the functional status and eligibility of Family Care members using a State health tool. Responsibilities include scheduling, conducting face-to-face interviews, maintaining documentation, and coordinating with Member Support Coordination staff. This role also involves crisis intervention referrals and participation in quality assurance activities.

The Senior Acquisition Integration Consultant manages the integration of acquired entities, focusing on project management and collaboration with stakeholders. Responsibilities include influencing departmental strategy, resolving complex issues, and ensuring the alignment of project objectives with the organization’s vision.

The LTSS Provider Education & Outreach Representative manages relationships with LTSS and HCBS providers in Indiana, ensuring their understanding of Humana policies and systems, overseeing onboarding and training, responding to inquiries, and organizing meetings to enhance provider experience and retention.

The Senior Campaign Development Engineer resolves complex campaign-related issues using data analysis to create population lists, develop automated workflows, and influence strategic decisions. This role requires advanced knowledge of healthcare data and experience in leading teams to improve consumer experiences through insightful data presentation and analysis.

The Provider Contracting Executive negotiates and executes contracts with healthcare providers, communicates contract terms, analyzes financial impacts, and maintains documentation. The role requires project leadership and skills in provider contracting, with minimal supervision and independent decision-making.

The Grievances & Appeals Representative 3 manages client denials and concerns through comprehensive reviews of clinical documentation, determining if grievances or appeals are warranted. They assist members with quality goals, investigate issues, and perform administrative tasks, utilizing strong data entry skills and experience in the healthcare field. Regular discretion in prioritizing requests is required, along with effective communication skills.

The Case Manager Assistant supports care management by assisting in non-clinical tasks such as assessing members' needs, reviewing medical records, ensuring compliance with care plans, and communicating with staff regarding any deficiencies. They also analyze data for quality improvement and assist in connecting members with appropriate resources.

The Coding Educator 2 improves provider documentation in the North East region by creating tailored education plans, reviewing medical records, and conducting educational sessions for providers and office staff. They collaborate with various departments to enhance quality care and document processes, often working independently on complex issues.

As a Senior Application Architect, you will design and develop robust, scalable application architectures, collaborating with teams to align software solutions with business goals. You will review emerging technologies, define performance metrics, and guide on application modernization to improve efficiency while ensuring code quality and performance.