Human Resources in United States

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 Humana’s Product organization is seeking a Lead Product Manager to drive the strategy, development, and optimization of the Adobe Experience Platform (AEP) in support of Adobe Web Integrations for Authenticated and Unauthenticated Web Channels. In this role, you will serve as a key product leader responsible for translating business needs into platform capabilities that enable personalized, data-driven customer experiences. You’ll work closely with cross-functional teams to deliver scalable solutions across Real-Time CDP, Journey Optimizer, and Customer Journey Analytics. This role is focused on growing adoption and usage of Adobe Experience Platform as an enterprise platform while supporting and scaling capabilities to support Authenticated (MyH) and Unauthenticated ( H.com) driving dynamic, context-aware customer engagement on Web channels. Success in this role means partnering with key lines of business to translate requirements into detailed product features for engineering teams to enable, while building decisioning strategies that optimize customer outcomes and business value. Key Role Functions Product Strategy & Vision Collaboratively own and manage the product backlo

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 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 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 Lead Software Engineer codes software applications based on business requirements. The Lead Software Engineer works on problems of diverse scope and complexity ranging from moderate to substantial. The Lead Software Engineer standardizes the quality assurance procedure for software. Oversees testing and debugging and develops fixes. Researches complaints and makes necessary adjustments and/or recommendations to resolve complex software related issues. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action. Key Responsibilities Technical Architecture and Ownership:** Design and own the end-to-end architecture of Centerwell's AI systems, including LLM-powered clinical tools, RAG pipelines, harnesses, agent-based workflows, and intelligent automation. Make and communicate foundational technical decisions in close collaboration with the broader engineering team. Model Development and Fine-Tuning:** Evaluate, select, and where appropriate guide the fine-tuning of foundation models. Establish model evaluation frameworks that prioritize safety, accuracy, and clinical relevance. Clinical and Product Partnership:** Collaborate closely with product managers, designers, clinicians, and data stakeholders to understand care delivery workflows and translate them into well-scoped, high-impact AI features. HIPAA Compliance and Responsible AI:** Ensure all AI systems are designed, deployed, and monitored in compliance with HIPAA and Humana's Responsible AI standards, including participation i

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 work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. As Centerwell builds its AI engineering function from the ground up, we need a platform foundation strong enough to support everything that comes next. As Lead Full-Stack Engineer focused on platform and API engineering, you will design and build the service layer that connects AI capabilities, data systems, and product frontends—setting the standards for how services are built, secured, and operated across the team. You will work with meaningful architectural scope, making decisions that span API design, security patterns, and deployment practices. The platform you build will serve care teams and patients across hundreds of Centerwell clinics. If you want to build platforms that others build on—and do it in service of better primary care—this is the role for you. Key Responsibilities Platform and API Architecture: ** Design and lead development of core backend services, REST and GraphQL APIs, and service-to-service integrations that connect all layers of Centerwell's AI product stack. Security and Compliance by Design: ** Establish patterns for authentication, authorization, rate limiting, PHI access control, and audit logging. Ensure HIPAA compliance is embedded in platform design from day one—not bolted on after the fact. AI and LLM Integration Patterns: ** Define and implement reusable patterns for integrating AI capabilities into product

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

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 <