Human Engineer in United States

Become a part of our caring community The Medical Coding Educator 2 identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. You will report to the Manager, Medicare Risk Adjustment. As the Medical Coding Educator 2 you will Arrange educational sessions with assigned providers aimed at quality of care and documentation improvements. Identify educational needs based on reports Prepare comprehensive reports and presentations on coding quality trends, risk areas, and educational outcomes using data visualization techniques. Provider onsite education Collaboration with other market provider facing role Use data analytics tools to assess coding quality, identify error patterns, and monitor compliance with internal and external standards. Analyze coding audit results and other relevant data to develop data-driven educational materials and interventions. Work with teams to improve documentation, data integrity, and workflow processes Use your skills to make an impact Required Qualifications AHIMA or AAPC CPC (Certified Professional Coder) Certification 3 or more years of medical coding education or auditing in a healthcare setting experience Proficiency with data analytics tools (such as Excel, Power BI, or similar) and experience interpreting large data sets Demonstrated knowledge of healthcare risk adjustment, including HCC coding and CMS-HCC model version 28. Experience speaking with leadership, webinars public speaking or presentation skills with healthcare providers Live in NC, SC, GA, VA or TN Preferred Qualifications Bachelor's Degree Value-based care Primary care Medicare Risk Adjustment kn

Become a part of our caring community The Medical Assistant 2 is the first point of contact for patient care. Responsible for administrative responsibilities in addition to patient care. The Medical Assistant 2 performs varied activities and moderately complex administrative, operational, and customer support assignments. Typically work on semi-routine assignments. The Medical Assistant 2 performs clinical duties such as discussing symptoms, obtaining vital signs, medication/vaccine administration, phlebotomy, collecting specimens, performing diagnostic screening tests, sterilizing/cleaning equipment, maintaining examination rooms, and documenting information into the electronic medical records system. Collaborate with Physicians and Advanced Practice Providers. Deliver direct patient care dependent on what active certification allows. Decisions typically focus on interpretation of area/department policy and methods for completing assignments. Work within defined parameters to identify work expectations and quality standards, but has latitude over prioritization/timing, and works under minimal direction. Follow standard procedures that allow opportunity for interpretation/deviation or independent discretion. Use your skills to make an impact Required 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 CPR Certified This role is considered patient facing and is part of the company's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB Bilingual proficiency in English and Spanish - must pass proficiency exam prior to foreign language communication Preferred Certified o

Become a part of our caring community The Care Coaching Assistant 2 (Transition Coordination Support Staff) employs a variety of strategies and techniques to support a member's wellness state by coordinating services and resources. The Care Coaching Assistant may support multiple responsibilities including Transitions. You/applicant/employee typically focuses decisions on interpretation of area/department policy and methods for completing assignments. Work within defined parameters to identify work expectations and quality standards, but has some latitude over prioritization/timing, and works. Follow standard practices that allow for some opportunity for interpretation/deviation or independent. Position Responsibilities: Contribute to administration of care coordination, for transitions and custodial prevention teams. Provide non-clinical support to the assessment and evaluation of members' needs and requirements. This support helps achieve and/or maintain an optimal wellness state by guiding members/families toward resources appropriate for their care and wellbeing. Additionally, it facilitates interaction with these resources. Perform varied activities and moderately complex administrative/operational/customer support assignments. Perform computations. Typically work on semi-routine assignments. Use your skills to make an impact Required Qualifications Less than 3 years of technical experience Must reside in the State of Indiana Proficiency in Microsoft Word, Excel and Outlook Excellent verbal and written communication skills Must Reside in the State of Indiana Preferred Qualifications Clerical support background in a healthcare environment Associate or Bachelor's Degree </

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 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 Compliance Professional ensures compliance with governmental requirements. The Senior Compliance Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Regulatory Compliance – State Enterprise Intake and Implementation – Senior Compliance Professional The Senior Compliance Professional implements new statues, regulations, rules and other regulatory guidance issued by state and federal regulators across the enterprise. Coordinates business partner engagement and implementation of rules. Researches compliance issues and recommends changes that ensure compliance with regulatory obligations. Provides compliance guidance and direction to business partners. Monitors metrics and other oversight tools that track implementation activity. Recommends new measures of compliance performance. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding implementation components. Exercises considerable latitude in determining objectives and approaches to assignments. The Senior Compliance Professional's primary focus will be to implement new federal and state rules, including PBM, across the enterprise. Key responsibilities may include: Serve as the subject matter expert and point-of-contact for individual state and federal implementations, leading implementation activity from onset to conclusion. Research, understand, and apply laws, regulations, and regulatory guidance for federal and state compliance issues. Analyze business requirements and complex issues, conduct research, and provide regulatory guidance to business partners, Law, Risk, and Compliance associate and leaders with regard to federal

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 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 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 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

Become a part of our caring community The Regional VP, Operations & Finance is accountable for the regional P&L. This seasoned Health Plan leader collects, analyzes and reports on various market data to connect financial outcomes with operational effectiveness. The Regional VP, Operations & Finance requires an in-depth understanding of health plan financials and how health plan operations impact financial performance. The Regional VP, Operations and Finance in the South Central (TX, OK and AR) region is a Chief Financial Officer position with Operations elements as well. The Regional VP, Operations and Finance requires an in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide to develop strategies to improve outcomes that support the region’s membership, medical expense, admin and margin targets. To be successful, the Regional Vice President, Operations and Finance will provide leadership and direction to the regional Finance team. In addition, this leader will serve as a member of the Regional Leadership team, collaborating with Provider Network, Health Services and Network Performance peers to lead product, network, quality and operational strategy and execution. This individual will lead the annual Medicare Advantage product bid process, working closely with enterprise product, finance and growth teams. As the Regional CFO, this leader will develop and provide fiscal and operational oversight of the regional annual budget, financial planning and projections, risk management and operational metrics and reporting. As a member of the regional leadership team, the RVP Operations & Finance must be comfortable with strategic discussions with physician and hospital leaders, and leading finance associates who identify financial drivers to performance of value-based providers. The role interfaces re

Become a part of our caring community The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team. This team manages post-acute care services. These services include Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME). The team's goal is to ensure members receive the appropriate level of care in the most appropriate setting. As a Utilization Management Registered Nurse: You will use clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. Using established medical criteria, you will make determinations based on information provided by the attending physician and other care providers You will complete request determinations within established processing time frames. (i.e. 10 reviews per day?) You will communicate with providers, members, or other parties to facilitate care and treatment. You will help deliver coordinated care for our members You will understand department, segment, and organizational strategy and operating goals, including their linkages to related areas. Use your skills to make an impact Required Qualifications: Must hold Compact Registered Nurse (RN) license in your state of residence Greater than one year of clinical experience as a RN in a hospital, SNF, Home Health, or acute care setting. Must be passionate about contributing to an organization focused on improving consumer experiences Preferr

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 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

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