Care Management Support Assistant in Nationwide

Become a part of our caring community As a Care Management Support Assistant, you will help members take the next step toward better health and well-being. You will do this by connecting with them over the phone, completing important non-clinical assessments, identifying barriers to care, and helping them access resources and benefits. We are looking for people who show compassion and document customer issues in detail, can work in a call center environment, and motivate themselves through work that directly supports members and care teams. This is a remote position, and the assigned shift will be 11:30 AM–8:00 PM Eastern Standard Time. Job Description What You Will Do Engage members by phone to encourage participation in care management programs. Complete required assessments and questionnaires to help identify health risks, care needs, and opportunities for clinical team follow-up. Assist members who need support scheduling doctor’s appointments or connecting with appropriate care resources. Identify and help address barriers to preventive screenings, benefits, and health-related services so members can close gaps in care. Support members in understanding, retaining, and accessing benefits that contribute to their overall health and well-being. Manage both inbound and outbound calls in an auto-dialer environment while documenting member information. What Success Looks Like You create a positive member experience by treating each interaction with respect, patience, and professionalism You demonstrate compassion, integrity, and sound judgment when supporting members with sensitive health-related needs You listen to

Become a part of our caring community The Medical Director, National Outpatient Medicare leverages clinical expertise and medical judgment to review preauthorization requests for services. This role is responsible for evaluating moderately complex to complex cases, where analysis of clinical information and situational factors requires in-depth assessment and sound decision-making. As a Medical Director at Humana , you will use your clinical expertise and judgment to make meaningful coverage and care determinations that support quality, consistency, and compliance across the healthcare continuum. In this role, you will review requests for services, level of care, and site of service, using nationally recognized clinical guidelines, CMS policies, medical references, and internal clinical resources to guide decision-making. This position offers the opportunity to work on complex outpatient cases , review clinical documentation, and collaborate with both internal partners and external physicians to gather additional information and discuss determinations. You may also contribute to care management activities and, depending on the role, provide input on areas such as clinical documentation, coding, grievances and appeals, and outpatient services or equipment reviews. Beyond case review, this role provides the opportunity to build strong relationships with physicians, provider groups, facilities, and community partners in support of regional priorities. It is a strong fit for physicians who are interested in contributing to value-based care, population health, and care management strategies while working in a structured environment that values sound clinical judgment, collaboration, and operational excellence. Humana is seeking a Medical Director to

Become a part of our caring community The Senior HR Business Partner will lead the people management agenda aligned to Medicaid RFP/RFI/RFA responses. Their work will align to standing up markets and supporting current markets in collaboration with the aligned HR Business Partner Lead (HRBPL) and act as a facilitator for the company's management team. They will need to apply broad experience in various Humana Resources (HR) areas of expertise. Work assignments will involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior HR Business Partner acts as a single point of contact for a broad range of business and HR partners across the Retail segment. Work will focus cyclically on the support of Medicaid RFA/RFI/RFP responses and the subsequent stand up or change of markets and work across partners in Medicaid, HR and other shared services to ensure the successful bid and stand up/operation of new and existing plans. In addition this work is closely aligned with the work of HRPBLs on this team and others to lead a strategy that ensures the successful growth and operation of our Medicaid line of business and facilitate superior member care delivery in all states. Responsibilities will include the identification, documentation, and implementation of best practices and support of the delivery of HR processes across Medicaid. This role will be accountable for identifying gaps, proposing and implementing changes necessary to cover risks and will act as a performance improvement driver and provoke positive changes in people management, lead change management projects and facilitate HR related internal and external communication. The successful candidate will influence our department’s strategy, make decisions on moderately complex to complex issues regarding technical approach for project com

Become a part of our caring community The Regional Senior TRICARE Community Liaison (TCL) is an important Humana Military representative committed to operational excellence, consistency, and accountability in the administration of TRICARE services within a defined territory in the East Region. You will provide expert guidance to nationally contracted healthcare providers and support facilities who have footprints across both East and West Regions. The primary focus of the Regional Senior TCL is to develop and sustain strong, collaborative relationships with all National Health System providers in the East Region. You will be cover all National contracted providers and large health systems regardless of location or type of care provided. Through clear and concise written and verbal communication, the Regional Senior TCL ensures provider understanding of the TRICARE health plan, TRICARE Policy and Regulations and how to navigate the Military Health System. The Regional Senior TCL is self-directed and uses independent, critical decision-making in managing time, setting priorities, addressing general inquiries, and resolving both straightforward inquiries, complicated problems and concerns raised by providers. This position upholds rigorous operational standards and ensuring consistent, high-quality delivery of TRICARE services. You will support customer service, conduct outreach, maintain network adequacy and access to care. You will manage provider relations and education, and ensure effective provider management within the assigned area. You will lead the review of TRICARE inquiries, complaints, and concerns from beneficiaries, providers, and government personnel, ensuring a resolution through professionalism and integrity. Additional responsibilities involve supporting the implementation of Alternative Payment Methodologies and Demonstration Pilots that adv

Become a part of our caring community The Clinical Programs Pharmacist Lead will be a part of a collaborative Pharmacy Stars team which is accountable for Humana’s Stars patient safety measure performance. The Clinical Pharmacist Lead autonomously develops, implements, and manages clinical program strategies to improve Medicare members' medication adherence and appropriate medication use. The Clinical Pharmacist lead exercises independent judgment and decision making on complex issues regarding job duties and related tasks, works under minimal supervision, and analyzes variable factors to determine the best course of action. Use your skills to make an impact Required Qualifications Degree of Doctor of Pharmacy (PharmD or RPh) from an accredited School of Pharmacy Active, unrestricted pharmacy licensure 5+ years of clinical experience in managed care or pharmacy related field, or equivalent Proficient in Microsoft Office applications (especially Word, Excel, and PowerPoint) Excellent written and oral communication skills Thrives in a fast paced, multi-project work environment while still ensuring attention to detail Successful track record in facilitating and consulting across teams and managing projects Strategic thinking and planning capabilities, organized, and detail-oriented Ability to learn quickly, work under pressure and timeline, work with ambiguity, and make complex decisions as necessary to meet business need Ability to assimilate, analyze, draw conclusions, and make recommendations from complex data Preferred Qualifications Previous experience in Medicare Stars Managed care and/or community pharmacy experience or residency/fellowship Previous experience in clinical program development and leader

Become a part of our caring community Provides executive leadership to Humana. The Regional Chief Medical Officer (CMO) is an entrepreneurial & experienced physician leader committed to the principles of comprehensive primary care and unlocking the power of value-based care for patients at national scale. S/he will be a proven clinician, leader, and strategist capable of driving the highest standards of care, building high-performance care teams, developing clinical leadership talent, and quantifiably improving outcomes and performance across multiple geographies. The Regional CMO will directly lead a team of regional & area medical directors and serve as dyad partner to the Regional Market President for one of the Primary Care Organization’s regions across the nation where CenterWell and/or Conviva serve patients. The Regional CMO will report to the Chief Medical Officer of the Primary Care Organization. This role requires periodic travel to markets (40% or less) to meet with national and regional teams and should be based in one of our current or upcoming CenterWell or Conviva markets. Responsibilities Drive Clinical Excellence in Culture & Performance · Build a best-in-class culture of engaged clinicians, focused on patient-focused care and clinical excellence, where doing the right thing for patients and team-based care within a value-based care framework, drives success and pride · Drive patient outcomes and population impact across regions for optimal results, across patient care experience & engagement, disease prevalence, quality/STARS, efficiency of care, and improved clinical outcomes and utilization. · Identify and act on opportunities

Become a part of our caring community The Dental Recontracting Professional initiates, negotiates, and executes dental provider contracts and agreements for an organization that provides dental insurance. The Provider Contracting Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. This is a VSP role - work specific hours to meet business needs on a limited term basis. The project is expected to go through mid-2027. The Dental Recontracting Professional - VSP will recontract Humana contracted dentists to our new agreement and as needed will communicates contract terms, payment structures, and reimbursement rates to providers. Maintains contracts and documentation within a tracking system. May assist with identifying and recruiting providers based on network composition and needs. 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 and work special projects as needed. This role is Variable Staffing Pool (VSP), Variable Staffing Pool Humana associates work specific hours to meet business needs on a limited term basis. The project is expected to go through mid-2027. This role is also eligible for limited benefits. Use your skills to make an impact Required Qualifications 2 - 5 years of experience negotiating managed care contracts with physician, hospital and/or other provider contracts and/or working with insurance in a dental office Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures a

Become a part of our caring community Humana Healthy Horizons is looking for a Value-Based Programs Lead who will support successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. You will lead the beginning-to-end operational support of specialty Medicaid value-based payment (VBP) models in alignment with segment strategy and goals. The Value-Based Programs Lead will be a subject matter expert in VBP and have advanced technical knowledge and experience. Develop new innovative VBP models for range of provider types, such as behavioral health, maternity, specialists, and social determinants of health, creating glide paths to move providers from volume to value. Align scope of work with roadmap for new VBP model development to ensure compliance with Medicaid contractual requirements and RFP commitments. Analyze financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care. Creation of VBP payment strategies and model design, such as developing payment model logic, performance metrics and benchmarks, and financial terms, which align with segment goals. Design and contribute to development of provider reporting packages to help providers understand their overall and detailed performance. Partner with finance team to conduct impact analysis and modeling for new VBP models. Collaborate with team members and matrixed teams to operationalize and rollout of new VBP models. Contribute to developing solutions to operational gaps. Monitor VBP model performance KPIs to identify opportunities to enhance model design based on internal and external feedback and performance data. Ability to translate strategy into models that can be piloted and scaled across markets. <

Become a part of our caring community The Actuarial Analyst 2, Analytics/Forecasting supports value-based initiatives within the HealthCare Economics team, partnering across actuarial, finance, analytics, and business teams to develop actionable financial insights and forecasting solutions. This role will play a key part in the design and development of a holistic modeling solution, building new methodologies and frameworks from the ground up to support performance measurement, financial reconciliation, and strategic decision-making across multiple value-based care programs. You work assignments are varied and frequently require interpretation of complex business issues, independent judgment, and the ability to recommend and execute appropriate courses of action with limited guidance. The Actuarial Analyst 2, Analytics/Forecasting will be responsible for analyzing and forecasting claims and revenue trends, developing innovative forecasting methodologies, and translating complex business requirements into scalable analytical solutions. This individual must be able to independently evaluate data, identify gaps, propose holistic approaches, and develop end-to-end solutions that integrate financial, operational, and claims-based insights. Responsibilities include designing forecasting methodologies, establishing reporting metrics, validating model results, and supporting the evolution of value-based care analytics. You will understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas. You will make decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Use your skills to make an impact Required Qualifications Bachelor's Degree Successful completion of

Become a part of our caring community The Market Finance Lead is a key member of the Gulf South Region’s finance team responsible for connecting market financial performance with operational effectiveness. This role will partner closely with Corporate Finance, Network Performance, Network Contracting, and regional Health Services teams. This individual will manage a team covering a diverse set of responsibilities around Medicare Advantage financial business operations with a heavy focus on value-based providers. This role reports to the Market Finance Director. This role analyzes financial results, claims experience, utilization trends, contract performance, membership, and provider performance data to identify opportunities, influence business decisions, and support market growth and operational improvement. The Market Finance Lead will partner closely with regional leadership, actuarial, corporate finance, clinical, risk adjustment, market operations, network performance, network contracting, sales/MarketPoint, and value-based care providers. This individual will translate complex financial and operational data into meaningful insights, recommendations, and action plans that improve performance across the market. As the Market Finance Lead, you will: Manage a team to review value-based providers’ financial performance, membership, cost and utilization trends, contractual results, and opportunities for improvement. Lead the financial portion of provider engagement prep sessions prior to joint operating committee meetings to advise the Network Performance team on contract performance and opportunities for improvement. Lead analysis and reporting related to value-based provider and contract performance, including financial results, utilization, claims experience, membership, and operational trends. Leverage data analytics, business ins