Community Health Worker in United States

Become a part of our caring community The Senior Process Improvement Professional analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Senior Process Improvement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Humana Pharmacy Benefits Management (PBM) Strategy Enablement team partners with PBM teams to improve processes that will help our members improve their lives through better health outcomes. This role, within the Process Improvement (PI) team of Strategy Enablement, will work closely with PBM leaders, as well as key partners in leading and delivering on initiatives and process capabilities that enable improved effectiveness, efficiency, and experiences (member, provider and associate). The Senior Process Improvement Professional: Researches best business practices within and outside the organization to establish benchmark data. Defines and leads business improvement projects aligned with business strategies and operational priorities. Collects and analyzes process data to initiate, develop and recommend business practices and procedures that focus on member experience, increased productivity and efficiency and reduced cost. Determines how new information technologies can support re-engineering business processes. May specialize in one or more of the following areas: benchmarking, business process analysis and re-engineering, change management and measurement, and/or process-driven systems requirements. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is perf

Become a part of our caring community The Telephonic Quality Outreach Professional supports the EPSDT program requirements in a telephonic outreach environment by evaluating member needs and helping families achieve or maintain an optimal state of wellness. The Telephonic Outreach Care Coach Professional 1 performs basic administrative/clerical/operational/customer support/computational tasks. Typically work on straightforward moderate complexity assignments that are routine and structured in nature. The Telephonic Quality Outreach Professional employs a variety of strategies and techniques to coordinate services and resources that facilitate HEDIS gap closure and improve pediatric health outcomes. The supervisor limits decisions to defined parameters around work expectations, quality standards, priorities and timing, and supervises closely and/or works within established policies/practices and guidelines with minimal opportunity for deviation. Position Responsibilities: Telephonic outreach to close HEDIS gaps for Medicaid pediatric population Assist members in addressing barriers to care, including scheduling challenges and transportation needs, to support access to primary care and overall well-being Collaborate with EPSDT Senior Quality Improvement Professional and Coordinator related to strategic outreach to maximize HEDIS outcomes Collaborate with other departments Provide vaccine awareness and education following Bright Futures and EPSDT preventive health guidelines Empower member independence through education and outreach that promote ongoing self-sufficiency in managing preventive and primary care needs Other responsibilities as assigned Use your skills to make an impact Required Qualifications Unrestricted Licensed Practical Nurse (LPN) in

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 Care Management Support Assistant contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Management Support Assistant performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments. The Care Management Support Assistant will review inbound referrals and correspondence for processing, fulfilment or resolution utilizing all appropriate software systems and resources. Screen physician’s orders and documentation to identify that all qualifying medical documentation and required information is included. When necessary, request additional applicable information from referring entity. Perform verification of benefits coverage and eligibility for services per Health Plan contract. Review referral data matching it against specified medical terms and diagnoses or procedure codes and follow established procedures for approving request or referring request for further review. Provide referral management education to members and providers regarding medical benefits, referral status and prior authorizations. Communicate with patient to confirm demographics and explain the details of the services/care requested. Coordinate the timely delivery of care and services with providers. Also communicate with referring entities, providers, and members regarding final referral determination while maintaining detailed documentation to record patient, physician, referral source and provider interactions and communications. Work with Pre-Authorization, Utilization Management, Billing, Pharmacy, and Home Care r

Become a part of our caring community As a Medical Assistant you will be the first contact for patient care, responsible for administrative responsibilities in addition to patient care. Working onsite in a clinical environment and reporting to the Center Administrator you will perform varied activities and moderately complex administrative, operational, and customer support assignments. Location Address CenterWell Senior Primary Care office located at: 4886 N Dowlen Rd., Beaumont, TX., 77708 You will be reporting to the: Supervisor, Center Administration Job Responsibilities As a Medical Assistant you will perform clinical tasks such as: You will perform pre-visit planning based on patient visit type You will obtain and record medical history and vital signs You will room patients and assist healthcare providers with medical procedures and treatments You will perform specimen collection and point of care testing You will prepare and administer medication under the direction of healthcare provider You will ensure accurate documentation in the electronic health record (HER) and electronic medical record (EMR) systems, including documentation of HEDIS and Stars quality measures Required Qualifications An active Certified Medical Assistant/CMA or Registered Medical Assistant/RMA certification from one of the following organizations: AAH, AAMA, AMT, ARMA, MedCa, NAHP, NAHT, NCCT, or NHA Successful completion of MA school/training program or a Certified/Registered Medical Assistant or 5+ years of experience and approval from Provider High school diploma or equivalent 1+ years of MA experience Phlebotomy experience Medication/vaccine administration ex

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 With over 10 million sales interactions annually, Humana understands that while great products are important, it’s the quality of our service that truly defines us. We know that when our members and prospects have delightful and memorable experiences, it strengthens their connection with us and enables us to put their Health First. After all, a health services company that has multiple ways to improve the lives of its customers is uniquely positioned to put those customers at the center of everything it does. The Manager, Sales Support plays a vital leadership role in enabling sales success and operational efficiency across the field sales organization. This role is responsible for managing a team of Sales Support Professionals, partnering with regional and channel leadership, and aligning cross-functional support across compliance, operations and other HQ partners. This individual supports effective execution of sales strategies and drives continuous process improvement to maximize field productivity and performance. Primary Duties and Responsibilities: Strategic Sales Support Serve as the lead point of contact for field execution of strategic initiatives. Support field execution of channel initiatives, product launches, and training deployments. Guide field teams through workflows and escalate issues when necessary. Support the deployment of career field channel initiatives to drive regional performance. Operational Execution & Performance Management Lead sales operations activities such as territory alignment, resource allocation, and performance reporting. Prepare reports and presentations for sales leadership, including performance dashboards and forecasts. Leverage in-market data to identify trends, opportunities, and risks, and translat

Become a part of our caring community Humana is seeking a Lead Product Manager, Medication Experience & Pharmacy Solutions to lead the strategy, discovery, delivery, and optimization of digital experiences that help members understand, manage, and maximize the value of their prescription benefits. This highly visible role sits at the intersection of pharmacy, health insurance, member experience, and digital product innovation. The Lead Product Manager will own the product lifecycle end-to-end, from identifying customer and business opportunities through defining features and stories, partnering across Design and Engineering, driving delivery, and measuring outcomes. Success requires strong strategic thinking, customer obsession, analytical rigor, and the ability to influence cross-functional stakeholders in a highly matrixed environment. The role directly supports Humana's goals of improving member experience, increasing digital engagement, reducing friction in medication-related journeys, and helping members make informed healthcare decisions. Why Join This Team This role offers a unique opportunity to solve meaningful healthcare problems at scale. You will help millions of members better understand their benefits, manage medications, reduce prescription costs, and make more informed healthcare decisions. Unlike many product organizations, our Product Managers own the entire product lifecycle, providing an uncommon level of ownership, accountability, and impact from strategy through implementation and measurement. Responsibilities Define and execute product strategy, vision, and roadmap for Medication Experience and Pharmacy Solutions Identify member, business, and operational opportunities through research, analytics, VOC, and stakeholder insights Lead product discovery efforts to validate problems, oppor

Become a part of our caring community The Principal Product Owner / Architect is a dual-mandate leadership role that unifies product strategy and solution architecture across CenterWell's four core business segments: Pharmacy, Primary Care Organization (PCO), Home Solutions, and Humana Military. This senior individual contributor serves as the connective tissue between business vision and technical execution—owning cross-segment product roadmaps while simultaneously authoring and governing the architectural blueprints that underpin them. You will operate within CenterWell IT – Cross-CenterWell Architecture, partnering with segment product leaders, engineering teams, EA Activation, security, data, and compliance to deliver integrated, interoperable health solutions that serve members, providers, and partners across the full care continuum. Your decisions shape what gets built, how it gets built, and the standard by which all four segments measure delivery readiness. DAY-TO-DAY Key Activities Define and own a unified cross-segment product roadmap that balances segment-specific priorities against shared platform investments, and communicates trade-offs clearly to leadership. Establish and maintain reference architectures, design patterns, and integration standards applicable across all four CenterWell segments. Conduct cross-segment discovery sessions, design workshops, and architecture reviews to surface shared needs, resolve competing priorities, and prevent duplicative build. Own and prioritize top-level product backlogs for shared platforms, partnering with segment product owners to decompose initiatives into delivery-ready user stories with clear acceptance criteria and non-functional requirements (NFRs). Define integration contracts, API standards, and domain boundaries for cross-segment data flows spanning pharmac

Become a part of our caring community You will support the CDAO, SVP of Data and Analytics, helping manage the day-to-day executive support needs of a large and complex organization of approximately 1,500 associates and partners. Delivering on Humana’s purpose of helping people achieve their best health requires a trusted and connected understanding of the people we serve and the ability to turn data and insight into action at scale. The Data & Analytics organization will achieve this vision by creating trusted enterprise data assets, contextualizing them for consumption, modernizing the platforms that power them, establishing clear accountability for their governance, and activating them through analytics, AI, and decision intelligence. This is an opportunity to support the leadership of one of Humana's largest technology organizations and contribute to initiatives that are modernizing healthcare technology, advancing AI-driven capabilities, and improving experiences for millions of members and providers. Success in this role requires exceptional organization, attention to detail, professionalism, and sound judgment. You will help ensure the executive is prepared, organized, and focused on key priorities by managing calendars, coordinating meetings and travel, supporting leadership events, handling communications, and partnering with stakeholders across the organization. What You'll Support Complex calendar management across four senior leaders and stakeholders Executive travel planning, meeting logistics , and event coordination

Become a part of our caring community Most AI engineering jobs are a thin wrapper around a model API. This role is different. We build the platform that transforms millions of clinical documents into trusted, actionable data. Our systems use large language models (LLMs) to read medical records, extract structured facts, answer complex questions with citations back to the source document, and route ambiguous cases to human experts for review. Our users make decisions that impact real healthcare outcomes, so “good enough” is not good enough. Building AI systems that are accurate, reliable, auditable, and scalable is at the core of this role. As a Senior AI Applied Engineer, you will design, build, deploy, and operate production AI systems used at scale within one of the largest health insurers in the United States. You will own solutions end-to-end, from user experience and APIs to model orchestration, evaluation frameworks, infrastructure, and production operations. Why Join Us Build production AI systems where LLMs are in the critical path, not just demos or proofs of concept. Work on extraction, retrieval, agentic workflows, and human-review systems that process real healthcare data at scale. Own projects end-to-end across frontend, backend, AI orchestration, infrastructure, deployment, and operations. Solve challenging problems around accuracy, explainability, traceability, and reliability in regulated environments. Ship quickly in a small, high-impact team that embraces AI-assisted development and rigorous quality standards. Build systems that continuously improve through expert feedback, evaluations, and human-in-the-loop workflows. Key Responsibilities Design, develop, and deploy full-stack AI-powered application

Become a part of our caring community The Field Care Manager Nurse 2 assesses and evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. You will report to the Manager, Care Management of Behavioral Health. The Field Care Manager Nurse 2 employs a variety of strategies, approaches, and techniques to manage a member's physical, environmental, and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. In this role, you will travel up to 50% of the time to support collaboration, conduct face-to-face meetings, and engage directly with staff, providers, members, and their families. Note: travel requirements have shifted and you will only need to travel up to 50%. Also, one of the questions within the application relate to travel and can't be adjusted to reflect the change. NOTE: You should reside in the Midlands OR Upstate area where your region will be. Use your skills to make an impact Required Qualifications Bachelor's in nursing (BSN) and have an active license in the state of South Carolina without disciplinary action. Must reside in the State of South Carolina 2 or more years of experience of case/care management 2 or more years working with the behavioral hea

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 The Program Delivery Lead, Medicare Advantage Bid Operations is responsible for coordinating and managing the annual Medicare Advantage bid planning, development, governance, and submission process. Serving as a central point of coordination across Product, Finance, Actuarial, Growth Strategy, Markets, Quality, and executive leadership teams, this role ensures key decisions, deliverables, and milestones are completed on time and with appropriate stakeholder engagement. This individual acts as the convener and coordinator of the bid operating model, managing the overall program calendar, overseeing program governance forums and processes, supporting coordination of new plan expansions with core strategic partners, and coordinating across executive stakeholders to ensure successful execution of a highly complex enterprise initiative. The Program Delivery Lead will operate in a highly matrixed environment and must be skilled at influencing without authority, managing strict deadlines, and serving as a key point of contact for questions about bid planning processes. In partnership with the broader Growth Strategy team, the Program Delivery Lead helps to drive continuous evolution of the Medicare Advantage bid operating model, governance structure, decision forums, and planning processes to improve organizational effectiveness and execution quality. Key Responsibilities Bid Program Management Develop and manage the integrated annual Medicare Advantage bid plan calendar, including milestones, deliverables, dependencies, and CMS deadlines Serve as the point person for bid planning and execution process governance questions and feedback Identify risks, issues, and dependencies that may impact bid execution and facilitate mitigation strategies Monitor overall program health and esc

Become a part of our caring community As a Sr Market Development Professional, you will serve as a non people leader, subject matter expert supporting the administration of TRICARE services. In this remote position, you will be required to live within a 60 mile radius of the US Southern Command headquarters in Doral, FL, in order to attend meetings and provide briefings when needed. You will be reporting to a Market Development Advisor. You will provide guidance, issue resolution, operational coordination, and subject matter expertise across TRICARE service delivery, provider, beneficiary, government stakeholder, and network-related matters. Use your skills to make an impact Required Qualifications Our Department of Defense Contract requires U.S. citizenship for this position Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services) HGB is not authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates that are currently living in Puerto Rico. Must live or be willing to relocate within 60 mile commute of US Southern Command office in Doral, FL as this position will require you to visit the office for meetings and to provide briefings when needed. Network management and development experience Managed care experience Experience with analysis of data and making decisions based on data Experience with improving customer satisfaction Preferred Qualifications Bachelor's degree TRICARE/Military Health system experience Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the