Community Manager in United States

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 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 The Talent Programs Coordinator-Variable Staffing Pool (VSP) supports the successful delivery of leadership development programs through exceptional coordination, logistics management, stakeholder support, and operational execution. You will ensure a seamless experience for participants, facilitators, and partners by managing program logistics, materials, technology, communications, and onsite execution. This is a growth-oriented, individual contributor role and is designed for someone who thrives in a fast-paced environment. You will have operational ownership and will design, deliver, and scale enterprise talent programs to learn and share how they work. While execution is core to the role, you will provide exposure to program strategy, data driven decision making, and process innovation. This role is part of the Variable Staffing Pool( VSP), which pays at an hourly rate. VSP Humana associates work part to full time hours based on business need. VSPs are not eligible for associate bonuses and receive limited benefits, which are effective upon hire. The hours for this role are generally aligned based on the associate and business task at hand. Key Responsibilities Program Coordination and Execution Coordinate logistics and operational activities for leadership development, talent, and early in career learning programs. Manage multiple programs, cohorts, timelines, and deliverables simultaneously. Develop and maintain project plans, checklists, schedules, and run-of-show documents to ensure flawless execution. Logistics, Materials & Vendor Management Coordinate program materials, printing, inventory, shipping, and supply management. Manage relationships and logistics with facilities, catering, venues, AV teams, and other partners. Ensure meeti

Work Flexibility: Hybrid The Sourcing Manager (Hybrid) will be responsible for developing sourcing strategies for defined suppliers and/or commodities for MAKO business unit. You will work to obtain the best quality, service, and value for products and services through effective bidding, negotiation, and supplier management. You will lead the development and implementation of specific strategies and projects related to cost reduction initiatives, supply base and sourcing optimization and rationalization, quality improvement, risk assessment, and contract negotiation. Hybrid located in weekly onsite with the ability to work for home This is a hybrid role. We are seeking a candidate in Weston, FL or surrounding area. The employee is expected to be physically present at a Stryker location on a weekly basis but has the flexibility to work from home. Key Areas of Responsibility Develop best in class strategic sourcing strategies for assigned suppliers and/or commodities in support of business objectives Implement supplier and/or commodity strategy which will include spend/supply assessments, consolidation strategy, sourcing selection, financial and make v’s buy analyses. Develop strong relationships with key suppliers as well as other disciplines within the businesses. Represent the ‘voice of the supplier’ in the organization Negotiate favorable long-term supply contracts and serve as the escalation point in resolving supplier challenges. Identify supply base risk, develop and implement mitigation plans Utilize market trends to identify and implement appropriate cost controls and business strategy changes. Perform cost analyses in partnership with Value Engineering and engage in cost-based negotiations with suppliers. Responsible for assuring cost standards are established

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 Consumer Experience Lead ensures optimized interaction between a company and members. The Consumer Experience Lead works on the remediation of identified issues from the Resolution team root cause hub to resolve member abrasion points on a diverse scope. You will report to the Director, Strategy Advancement. As the Consumer Experience Lead you will Lead strategic and operational initiatives that improve business performance, organizational effectiveness, and cross-functional execution Analyze complex issues to identify root causes, uncover improvement opportunities, and recommend sustainable solutions. Build relationships, influence decision-making at all levels, and communicate recommendations Manage escalations, resolve issues, and accountability for commitments, deliverables, and action items across teams Strengthen operations through documentation, strategies, self-service resources, process optimization, and decision-support materials for leadership Use your skills to make an impact Required Qualifications Bachelor's degree 3 or more years of experience in Healthcare operations 3 or more years of project management experience 3 or more years of project leadership experience Demonstrated analytical with experience identifying root cause and implementing sustainable solutions Live in EST or CST time zone Preferred Qualifications Experience supporting executive leadership teams or enterprise-wide strategic initiatives Experience with operation excellence, process improvement methodologies, or business transformation efforts Demonstrated Executive leadership experience with communication strategy skills <p style="text-align:inheri

Become a part of our caring community The Senior Product Owner is responsible for conveying product vision and roadmap to an Agile delivery team by defining user stories and prioritizing product backlog. The Senior Product Owner work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Senior Product Owner maximizes value of product created by Agile team. Liaises with stakeholders and the development team ensuring the right product is being built, in the right order, within budget and by the deadline. Serves as the Agile team's primary contact for information, work prioritization, and decision-making. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, andwork is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments. This is a remote position and you will report to the Director, Product Management. This position is created specifically to assist with Humana's efforts to secure and, if awarded, transition into a new business opportunity. Please note that continued employment in this role is expressly contingent upon Humana's receipt of the business opportunity and a satisfactory transition into the work. In the event Humana does not pursue the opportunity or determines that a timely and satisfactory transition cannot be achieved, employment may be subject to termination. Use your skills to make an impact Required Qualifications You will have a Bachelors degree or equivalent You will have 3&#43; years of technical experience, product ownership, or project management experience You will be Certified SAFe®

Become a part of our caring community The Counsel provides a full range of legal advice and services on litigation, arbitration, and related legal matters and strategy. The Counsel will collaborate internally and with outside counsel on case strategy, discovery, and resolution of disputes. The Counsel will exercise independent judgment and decision-making on litigation issues and related tasks and work under modest supervision. This role requires applying in-depth and broad knowledge of litigation practices, frequently taking full ownership of legal matters, and organizing and managing individual litigation matters from inception through trial. Use your skills to make an impact Required Qualifications Juris Doctor degree from an ABA-accredited law school Active and licensed membership in a state bar association At least 4 years of experience in litigation Strong project management and organizational skills across all facets of litigation from inception through trial Ability to organize and successfully manage a number of case matters simultaneously Strong skills in communicating complex legal issues to various stakeholders Ability to mitigate risk by acting as a trusted advisor whose strategic thinking, pragmatic problem-solving, and proactive counsel are sought by clients Ability to work independently under general supervision and in team settings Experience with large-scale e-discovery Preferred Qualifications Experience with provider disputes and healthcare reimbursement disputes Experience with alternative dispute resolution (ADR), including arbitration Understanding of Medicaid/Medicare laws and regulations Work at Home Requirements:

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 The Senior Quality Improvement Professional leads efforts to improve clinical quality and provider performance for the Humana Healthy Horizons in South Carolina Medicaid Plan. You will develop and implement cross-functional quality improvement initiatives, evaluate business processes and performance outcomes, and drive sustainable, measurable improvements. Reporting to the Quality Improvement Director, you will collaborate with internal and external stakeholders to advance a provider-focused culture of quality and performance excellence. You will manage complex projects and analyze diverse data sources to identify opportunities, inform strategy, and support organizational objectives. The Senior Quality Improvement Professional leverages data to lead quality improvement initiatives, monitor performance metrics, and support provider performance enhancement. This role collaborates with provider-facing teams to implement targeted interventions, develop educational resources, and drive achievement of quality and member experience goals. The position leads and participates in multidisciplinary committees, provides strategic clinical guidance on quality initiatives, and influences business decisions through data-driven insights. Operating with a high degree of independence, the Senior Quality Improvement Professional manages complex projects, exercises sound judgment, and recommends solutions to advance organizational objectives. Essential Role Responsibilities The Senior Quality Improvement Professional is responsible for improving clinical quality and performance outcomes among South Carolina network providers. Key responsibilities include: Partner with Provider Engagement, Network, and Contracting teams to implement clinical quality improvement strategies including education, training and performanc

Become a part of our caring community Humana, a Fortune 60 Healthcare Company Humana is a publicly traded, Fortune 60 health benefits company with a long history of successful innovation and reinvention. It has transformed itself from the largest US nursing home company in the ’60s, to the largest US hospital corporation in the ’80s, to a leading health benefits company beginning in the ’90s. Today, Humana is a leader in consumer-focused health solutions and is one of the largest health benefits organizations in the country. The Consumer Product s Enablement & Solutions department supports Humana’s businesses by ensuring co nsumer products are competitive and meet consumer needs. The team also enables growth across the organization and ensures timely CMS and state filing timelines. The team has a strong dotted-line partnership with the Medicare and Medicaid organization, Humana’s largest , which comprises over 80% of the company’s total revenue and the majority of its earnings . Team members partner broadly with leaders throughout the enterprise, as they provide oversight and strategic direction of all Medicare and Duals products. Humana is seeking an experienced team member to help drive strategic direction and ensure execution on the end-to-end proces ses and projects critical for transformation across our business . As a Consultant , you will <

Become a part of our caring community The Network Operations Coordinator 4 manages provider data for health plans including but not limited to demographics, rates, and contract intent. Manages provider audits, provider service and relations, credentialing, and contract management systems. Executes processes for intake and manage provider perceived service failures. Decisions are regarding the daily priorities for an administrative work group and/or external vendors including coordinating work activities and monitoring progress towards schedules/goals, and often oversees work of others and/or is the primary administrative owner of a main process, program, product or technology. Works within broad guidelines with little oversight. Use your skills to make an impact Required Qualifications Minimum of 2 years of provider relations experience, healthcare services or related experience Minimum of 1 year of experience managing mid to large scale projects Intermediate experience in Microsoft Word, Outlook, Excel (VLOOKUP’s, lateral lookups & ability to manipulate data) and TEAMS Ability to accommodate a work schedule following Central Standard Time zone hours Preferred Qualifications Advanced experience with Microsoft Excel Provider contract interpretation experience Previous account management or project management Knowledge of medical claims Work at Home Requirements: To ensure Home or Hy

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 Are you ready for a great job? The Value-Based Programs Analyst supports successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. The Value-Based Programs Analyst work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action The Value-Based Programs Analyst understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas to include, but not limited to: the Value-Based organization, Enrollment, Product Development, Market Finance, Corporate Finance, Actuarial, Network Contracting, and National Contracting. Analyzes provider financial patterns and trends utilizing excel and/or SQL Updates, maintains, and reviews fee scheduling and pricing structures Thoroughly reviews provider contracts and ensure rates are priced and applied accurately Identifies process recommendations and ensures compliance with government regulations Collaborates and communicates with internal partners of all professional levels within various departments The ideal applicant will have the following skills: Problem Solving Provider Management Relationship management Consumer Experiences Confidentiality Data Analysis Detail-Oriented Written Communication In addition to being a great place to work, Humana also offers industry-leading benefits for all employees, starting your FIRST day of employment. Benefits include: Medical Benefits Dental Benefits Vision Benefits Health Savings Accounts Flex Spending Accounts Life Insurance 401(k) PTO including

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