Community Manager Jobs

Become a part of our caring community The Clinical Pharmacist Principal designs, implements, and optimizes clinical programs across healthcare delivery systems. This team member provides strategic advice and guidance to functional team(s). Highly skilled with broad, advanced technical experience. The Clinical Pharmacist Principal works with senior executives to develop and drive segment or enterprise-wide functional strategies. Advises one or more areas, programs or functions and provides recommendations to senior executives on matters of significance, and as an advanced subject matter expert competent to work at very high levels in multiple knowledge and functional areas across the enterprise. Use your skills to make an impact Required Qualifications Doctor of Pharmacy (PharmD) degree from an accredited college of pharmacy Active pharmacist license in good standing Demonstrated experience leading enterprise or cross-functional strategic initiatives Experience designing, implementing, or evaluating programs Strong analytical and data interpretation skills Strong executive communication and presentation skills Experience influencing stakeholders across multiple organizational levels Ability to manage ambiguity and lead complex initiatives from concept through execution Additional Information: As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Work at home requirements: To ensure Home or Hybrid Home/Office employees' ability to work

Become a part of our caring community The Counsel provides a full range of legal advice and services. The Counsel work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Counsel typically a Legal generalist or provides counsel in a combination of disciplines. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. Use your skills to make an impact Responsibilities: Be a part of the legal team -- use your legal expertise to drive healthcare strategy. Humana is seeking legal counsel who will support Humana and its management by: Providing legal advice and support for Humana’s Medicare Advantage lines of business; Advising on Medicare Advantage rules and regulations and related health care fraud and abuse laws, including the Anti-kickback statute and False Claims Act; Drafting contract provisions to address regulatory concerns; and Collaborating and consulting with leaders throughout the company in order to ensure full compliance with applicable laws and regulations, and protection against external risk. Required Qualifications: Juris Doctorate, with licensing in at least one state At least 3 years of experience in health law at a law firm or in-house health care organization Experience in Medicare, Medicaid, or similar regulatory work Strong legal research, analytical, and writing/oral communication skills Experience negotiating contracts </l

Become a part of our caring community The Research Scientist 2 participates in research study design, analysis and interpretation of results, with special emphasis on statistical and analytical plan development; data acquisition, preparation, and management; statistical analysis and interpretation of findings. The Research Scientist 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Humana’s Healthcare Quality & Reporting Improvement (HQRI) department is seeking a Research Scientist 2 to join a high-performing team dedicated to advancing predictive modeling and analytics in support of our Medicare and Medicaid business. The HQRI team plays a pivotal role within Humana, delivering insights that drive the effectiveness of risk adjustment initiatives. In this position, the Research Scientist 2 will partner with a senior research scientist to apply advanced statistical methods to rigorously evaluate the impact of risk adjustment programs and pilot projects. The findings generated will be critical in informing key business decisions and optimizing operational strategies. Additionally, the person in this role will collaborate with colleagues specializing in data science and actuarial analytics. We are seeking a candidate who brings complementary skills to the team, with the ability to learn from their teammates while contributing with their unique expertise in statistical analysis. Use your skills to make an impact Required Qualifications Bachelor's degree in Computer Science, Data Science, Mathematics or a related quantitative field; 2 years of experience applying statistical modeling, pred

Become a part of our caring community The Senior Data & Reporting Professional supports the Michigan Integrated Long-Term Services and Supports (MI LTSS) program through advanced analytics, operational reporting, performance monitoring, regulatory compliance reporting, and strategic data management. You will transform complex clinical, operational, quality, and financial data into actionable insights that support program oversight, state contract compliance, quality improvement initiatives, and executive decision-making. Your work assignments involve moderately complex to complex issues where analysis of situations or data requires an in-depth evaluation of variable factors. You will work independently, exercises considerable latitude in determining objectives and approaches to assignments, and begin to influence departmental strategy. The Senior Data & Reporting Professional partners closely with LTSS Care Management, Utilization Management, Quality, Finance, Compliance, Provider Operations, and Market Leadership to monitor program performance, identify operational opportunities, and support achievement of LTSS program requirements. Develop and maintain operational, clinical, quality, compliance, and executive dashboards supporting the MI LTSS program. Integrate and validate data from multiple systems, including care management platforms, quality monitoring tools, provider networks, claims data, assessment systems, and regulatory reporting sources. Create recurring and ad hoc reports supporting operational performance, regulatory compliance, quality improvement initiatives, and strategic program planning. Monitor LTSS performance indicators including Health Risk Assessments, InterRAI assessments, Nursing Facility Level of Care Determination (NFLOCD) completion, Person-Centered Service Plans, Integrated Care Team (ICT) participation,

Become a part of our caring community Lead Enterprise Architect, Enterprise API and Integration is an important role in leading the technology transformation efforts focused on defining the architecture, standards and governance for API development across the enterprise. Job Description The Lead Enterprise Architect will establish and govern a comprehensive enterprise API ecosystem by bringing together API providers and consumers through a unified, business-aligned API catalog. This role ensures effective lifecycle management, promotes reuse, and drives consistency across all enterprise integrations while enabling AI-driven and agentic capabilities. Key Responsibilities Define, evolve, and promote enterprise API architecture, design patterns, and standards, including transition and target-state architectures. Lead enterprise-wide API governance, including intake, design review, lifecycle management, and compliance enforcement. Partner with architecture, engineering, security, data, and business teams to drive adoption of API standards and reusable integration patterns. Build and scale enterprise API platforms enabling federated development, developer self-service, and catalog-driven discovery. Develop AI-enabled governance capabilities, including automation, AI-ready API design, and gap detection across the API lifecycle. Define and implement reference architectures for modern integration patterns, including: Event-driven architectures Microservices integration LLM integration, RAG, and vector data platforms Architect and operationaliz

Become a part of our caring community The Inbound Contacts Representative 2 represents the company by addressing incoming telephone, digital, or written inquiries. The Inbound Contacts Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. The Inbound Contacts Representative serves as a primary point of contact for customers, providing support through phone, digital, and written channels. This role handles a variety of customer inquiries, resolves issues, and delivers accurate information while ensuring a positive customer experience. The position performs moderately complex customer service, administrative, and operational support activities, manages semi-routine assignments with minimal guidance, and exercises sound judgment to support quality service and customer satisfaction. As an Inbound Contacts Representative, you will: Respond to customer inquiries by phone, digital, or written channels, including benefits questions, issue resolution, and member education. Accurately document customer interactions, requests, concerns, and resolutions in applicable systems. Research and resolve customer issues, escalating complex or unresolved matters as appropriate. Apply established policies, procedures, and resources to deliver accurate and timely support. Use critical thinking and sound judgment to address customer needs and recommend solutions. Manage workload effectively, prioritize tasks, and meet quality and service expectations. Work independently within established guidelines while supporting customer satisfaction and business objectives. Use your skills to make an impact Required Qualifications 3

Become a part of our caring community The Senior Full Stack Engineer Performs software engineering activities in all layers of the stack, from setting up the database to programming in the back-end and the appearance at the front-end. The Senior Full Stack Engineer works on problems of diverse scope and complexity ranging from moderate to substantial. You will report to the Associate Director of Software Engineering. The Senior Full Stack Engineer is involved in all stages of software development. This includes front-end development, back-end development, database integrations, network and hosting management, user interface, user experience, and back-end server management. You are experienced with Cloud-based services and development end-to-end. You can work with autonomy while collaborating with others on architectural and process decisions. You are comfortable with giving and receiving feedback from your teammates and others in the organization. You conceptualize what you need to do from incomplete and evolving requirements. Experience communicating updates and resolutions to customers and other partners. On any given day you may: Contribute to technical architecture reviews and design as well as present vision Expertise using advanced data structures and algorithms Possess the ability to evaluate problems in both strategic and tactical terms Mentor and assist in coaching a small team of high-caliber engineers Drive positive change with technical vision and innovative solutions Strong affinity to software-driven engineering & automation Partner with the business and stakeholders to define technical direction & work cross functionally Deliver business-critical systems and compon

Become a part of our caring community The Senior Portfolio Enablement Lead is a strategic portfolio transformation role responsible for shaping and enabling Humana's portfolio operations, Agile Release Train (ART) design, and Ways of Working across the portfolio. Acting as a trusted advisor to senior executives (SVPs, VPs, and portfolio leaders), the role translates transformation strategy into scalable execution by diagnosing portfolio delivery challenges, guiding organizational design, and improving alignment, flow, and value delivery. As a Senior Portfolio Enablement Lead, you will: Partner with portfolio and organization leadership to develop and enable portfolio, aligned to enterprise portfolio operations to achieve portfolio initiatives their outcomes. Perform quantitative and qualitative assessments, including stakeholder analysis and change impact assessments, to develop data-driven change strategies for key stakeholder groups. Build and manage portfolio transformation roadmaps to drive executive buy-in and sponsor engagement across technology and business/product leadership and leadership to drive understanding and adoption of key changes Develop Release Train Engineers to our Humana Ways of Working and enterprise tooling subject matter experts for Agile Release Trains and Scrum Teams Measure effectiveness of change interventions through defined metrics and continuously evolve plans to optimize adoption outcomes Regularly report activity status to organizational, portfolio and transformation leadership; proactively escalate and help resolve risks and issues Partners with leaders to align all continuous improvement goals and objectives Partner with Release Train Engineers in the portfolio to monitor activity level of continuous improvement, adoption of Humana Ways of Working, risks patterns

Become a part of our caring community The Director, Provider Solutions Engineering devises an effective strategy for executing and delivering on IT business initiatives. We ask that you have an in-depth understanding of how organization capabilities interrelate across the function or segment. The Director, Provider Solutions Engineering serves as the strategic technology leader responsible for defining Humana's Provider engagement and engineering. In partnership with business and operational teams, this role is responsible to identify and implement strategic technology solutions that improve provider engagement, associate effectiveness, and business outcomes. The Director collaborates across a highly matrixed organization to establish technology strategy, drive large-scale transformation initiatives, and deliver modern customer relationship management capabilities that support the end-to-end provider experience. This leader is accountable for translating business priorities into actionable roadmaps, driving execution excellence, strengthening engineering discipline, and ensuring technology investments align with enterprise architecture, regulatory requirements, and organizational objectives. The role is responsible for establishing the future-state Provider engagement vision, accelerating AI-enabled capabilities, modernizing technology platforms, and fostering a high-performing engineering culture that consistently delivers measurable business value. Key Responsibilities Technology Leadership Serve as the strategic technology leader for Provider engagement and related provider experience capabilities. Partner effectively within a matrixed organization to align business priorities, regulatory requirements, architecture standards, and technology investments. Provide strategic dir

Become a part of our caring community Humana invites MBA and other advanced-degree students to join its Summer 2027 Internship Program. This immersive experience allows students to contribute to meaningful, enterprise-level work across a range of business functions, engage with executive leaders, and develop the skills and perspective needed for a successful healthcare career after graduation. We are seeking purpose-driven leaders who demonstrate intellectual curiosity, agility, sound judgment, and a high degree of emotional intelligence. Strong candidates embrace complex challenges, navigate ambiguity confidently, and are motivated to shape the future of healthcare. MBA Primary Care & Clinical Innovation Internship opportunities are available across several strategic areas, including: Clinical Performance & Innovation CenterWell Primary Care Organization Primary Care Organization Practice Technology Portfolio & Change Management Value Based Care Enablement Medical Specialty Operations Across these strategic areas, interns help translate priorities in primary care and clinical innovation into action through strategic planning, business case development, cross-functional coordination, process improvement, portfolio execution, and transformation support. They may contribute to initiatives that strengthen clinical performance, advance technology-enabled care, improve operational efficiency, and deliver greater value for patients and the enterprise while supporting sound governance and continuous improvement. Location and work arrangement : This is a 12-week, in-person internship based primarily at Humana’s headquarters in Louisville, KY, with limited opportunities in Arlington, VA; Chicago, IL; Fort Lauderdale, FL; Boston, MA; Nashville, TN; and New York

Become a part of our caring community The Grievances and Appeals Representative 4 role in the Internal Review Team is responsible for managing appeal denials, by reviewing clinical documentation, determining whether further action is needed, and validating final determinations in coordination with clinical and internal Humana partners. Key Responsibilities: Manage Level 1 appeal cases , ensuring accuracy, completeness, and compliance with CMS requirements Review clinical documentation to support appeal determinations and escalation decisions Coordinate with clinical teams and internal partners to finalize appeal outcomes Investigate and resolve member and provider issues with a focus on timely resolution Maintain high productivity and quality standards in a production-driven environment Ensure strict adherence to confidentiality and compliance regulations Independently prioritize and manage multiple high-volume case assignments Proactively embraces change and supports smooth transitions in a dynamic work environment Use your skills to make an impact Required Qualifications: 1&#43; year of grievance & appeals and/or customer service experience Strong data entry skills Proficiency in Microsoft Office Applications Experience in a production-driven environment Experience prioritizing and delivering multiple assignments Strong commitment to confidentiality and high-quality results Preferred Qualifications: Associate's or Bachelor's degree 2–4 years of grievance and appeals experience Medical claims processing experience Previous inbound call center experience Experience wi

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

Become a part of our caring community The Associate VP, Quality Engineering carries out procedures to ensure that all information systems products and services meet organization standards and end-user requirements. The Associate VP, Quality Engineering requires a in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide. The Associate VP, Quality Engineering performs and leads tests of software to ensure proper operation and freedom from defects. May create test data for applications. Documents and works to resolve all complex problems. Reports progress on problem resolution to management. Devises improvements to current procedures and develops models of possible future configurations. Acts as information resource about assigned areas to technical writers. Performs complex work flow analysis and recommends quality improvements. Decisions are typically related to intradepartmental coordination, development and implementation of strategic plans, and business outcomes, and develops and implements strategic plans for the scope of management that are aligned with the Segment or Business strategy. Use your skills to make an impact Required Qualifications Bachelor's degree in a technology field Extensive experience in the information technology field Demonstrated success in leading and developing a team of associates. Expertise in software testing methodologies Record of success in leading quality improvement initiatives Certified Software Test Engineer (CSTE) designation. Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications Master's degree in a technology field Additional Informa

Become a part of our caring community The Pre-Authorization Nurse reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Pre-Authorization Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Pre-Authorization Nurse completes medical necessity and level of care reviews for requested services using clinical judgment, and refers to team members for review depending on case findings. Educate providers on utilization and medical management processes. Enter and maintain relevant clinical information in various medical management systems. Understand 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. Use your skills to make an impact Required Qualifications 2&#43; years of RN experience Active RN license in the state of Indiana Ability to be licensed in multiple states without restrictions Previous experience in utilization management, case management, discharge planning and/or home health or rehab Proficient with MS Office products including Word, Excel and Outlook Ability to work independently under general instructions and with a team Preferred Qualifications Bachelor's degree MCO experience Health Plan experience working with large carriers Previous Medicare/Medicaid experience Outpatient or home health experience in Utilization Manageme

Become a part of our caring community We are looking for a highly motivated Senior Technology Leadership professional to join our IT Operations team. You will support the Lead of the Application Operations Center and Enterprise Post Production Validation teams, with a focus on process automation, innovation, and continuous improvement. You will work with both onshore and offshore resources, ensuring in daily tasks, enhancing application support, and driving improvements in monitoring and validation processes. Main Responsibilities: Collaborate with the Lead to provide operational and strategic support for Application Operations Center and Post Production Validation teams. Identify, evaluate, and implement automation opportunities to increase efficiency and reduce manual workload. Drive process innovation by recommending and deploying advanced tools and methodologies for application operations and validation activities. Analyze existing workflows and develop documentation for standard operating procedures and best practices. Oversee daily application support and monitoring activities to ensure system stability, performance, and reliability. Partner with onshore and offshore teams to coordinate task execution and promote consistent adoption of new processes and technologies. Develop and maintain dashboards and reports to track key performance indicators and present findings to leadership. Ensure automation and process improvements comply with organizational standards and regulatory requirements. Facilitate knowledge sharing, training sessions, and change management activities to support team development and successful project implementation. Engage with stakeholders to gather requirements, understand challenges, and communicate progress on automation initiatives. Ability to create