Qureos Mentor

Humana

<div>
 
 Become a part of our caring community and help us put health first
 
 
 
 Full-Time, Remote Telephonic opportunity
 
 
 The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require
 
 
 interpretation and independent determination of the appropriate courses of action.
 
 
 As a Utilization Management RN working on the OneHome/Home Solutions UM Team, you will have the opportunity to use your clinical knowledge, communication skills, and independent critical thinking skills to ensure value-based care for members who desire to heal at home.
 
 
 In this role you will coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment.
 
 
 
 Role
 
 
 
 The Utilization Management Nurse 2 helps to ensure fully coordinated care at home for our members. Success in this role requires the following:
 
 
 <ul>
 <li>
 Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
 </li>
 <li>
 Excellent organizational and time management skills
 </li>
 <li>
 Solid analytical skills to understand and interpret clinical information to make recommendations to improve patient outcomes.
 </li>
 <li>
 Technical savvy and ability to navigate multiple systems and screens while working cases.
 </li>
 <li>
 Collaboration skills to effectively interact with multiple parties both internal and external.
 </li>
 <li>
 An understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
 </li>
 <li>
 Ability to make decisions regarding your own work methods, occasionally in ambiguous situations, and with minimal direction receiving guidance where needed.
 </li>
 <li>
 Ability to follow established guidelines, processes, and procedures.
 
 
 </li>
 </ul>
 
 Use Your Skills To Make An Impact
 
 
 
 Shift is Monday - Friday 8:00am - 5:00pm Eastern Standard Time
 
 
 
 Required Qualifications
 
 
 
 <ul>
 <li>
 Minimum of Associate Degree in nursing
 </li>
 <li>
 Licensed Registered Nurse (RN) in a compact state with no disciplinary action.
 </li>
 <li>
 Must have valid compact license or reside in a compact state and be eligible to upgrade to compact licensure.
 </li>
 <li>
 Three (3) or more years of progressive and varying clinical experience that includes direct patient care to geriatric population
 </li>
 <li>
 Effective telephonic and virtual communication skills
 </li>
 <li>
 Comprehensive knowledge of Microsoft Word, Outlook and Excel
 </li>
 <li>
 Ability to work independently under general instructions and within a team.
 
 
 </li>
 </ul>
 
 Preferred Qualifications
 
 
 
 <ul>
 <li>
 Bachelor&rsquo;s degree
 </li>
 <li>
 Two (2) or more years of home health experience and/or utilization management experience
 </li>
 <li>
 Experience in a managed care setting
 </li>
 <li>
 Health Plan experience
 </li>
 <li>
 CGX experience
 
 
 </li>
 </ul>
 
 Work-At-Home Requirements
 
 
 
 <ul>
 <li>
 Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role).
 </li>
 <li>
 A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required.
 </li>
 <li>
 Check your internet speed at www.speedtest.net
 </li>
 <li>
 A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information
 
 
 </li>
 </ul>
 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
 
 
 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
 
 
 
 Scheduled Weekly Hours
 
 
 
 40
 
 
 
 Pay Range
 
 
 
 The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
 
 
 $71,100 - $97,800 per year
 
 
 This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
 
 
 
 Description Of Benefits
 
 
 
 Humana, Inc. and its affiliated subsidiaries (collectively, &ldquo;Humana&rdquo;) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
 
 
 
 About Us
 
 
 
 About OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients&rsquo; homes. OneHome&rsquo;s patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.
 
 
 About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first &ndash; for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health &ndash; delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
 
 
 
 Equal Opportunity Employer
 
 
 
 It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
</div>

Utilization Management Nurse - Home Solutions - Compact RN Required

<div><h1 class="jobSectionHeader">Become a part of our caring community and help us put health first 
</h1>
Join Humana&rsquo;s In Home Well-being Assessment (IHWA) team team and lead the management of key vendor relationships that drive in-home health and well-being assessments for Medicare members. As a Program Delivery Lead, you&rsquo;ll own vendor partnerships, monitor contractual obligations, and ensure compliance with CMS guidelines&mdash;all while supporting Humana&rsquo;s Retail bid goals and Medicare Risk Adjustment requirements. This role requires strong task management, project management, independent decision-making, and the ability to operate in times of ambiguity.
Key Responsibilities<ul><li>
Serve as the primary point of contact for one or more IHWA vendors, building strong, productive partnerships.</li><li>
Manage and monitor vendor deliverables, contractual obligations, and service-level agreements.</li><li>
Track, prioritize, and oversee a high volume of vendor activities while supporting internal Humana partners.</li><li>
Ensure compliance with CMS guidelines and Medicare Risk Adjustment standards.</li><li>
Collaborate with Stars program teams to manage vendor activities tied to quality and risk adjustment goals.</li><li>
Operate independently, make decisions in ambiguous situations, and manage multiple projects simultaneously.</li><li>
Proactively identify issues, communicate findings, and influence process improvements.</li></ul><h1 class="jobSectionHeader"> 

Use your skills to make an impact 

</h1>Required Qualifications<ul><li>
Bachelor's degree or equivalent experience</li><li>
6 or more years of large project implementation or vendor management</li><li>
2 or more years of project leadership experience</li><li>
Strong knowledge of Microsoft Office XP products (Word, Excel, Access)</li><li>
Excellent communication skills, both oral and written</li><li>
Strong relationship building skills</li><li>
Must be passionate about contributing to an organization focused on continuously improving consumer experiences</li></ul>
Required Travel: Quarterly vendor meetings required, plus occasional ad hoc travel. Estimated total travel: 6&ndash;7 trips per year.
Preferred Qualifications<ul><li>
Master's Degree in Business Administration or a related field</li><li>
PMP certification a plus</li><li>
Six Sigma Certification also a plus</li><li>
Knowledge and experience in health care environment/managed care</li><li>
Strong analytical skills</li></ul>
Additional Information
Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security&mdash;both today and in the future, including:<ul><li>
Health benefits effective day 1</li><li>
Paid time off, holidays, volunteer time and jury duty pay</li><li>
Recognition pay</li><li>
401(k) retirement savings plan with employer match</li><li>
Tuition assistance</li><li>
Scholarships for eligible dependents</li><li>
Parental and caregiver leave</li><li>
Employee charity matching program</li><li>
Network Resource Groups (NRGs)</li><li>
Career development opportunities</li></ul>
To ensure Home or Hybrid Home/Office employees&rsquo; ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:<ul><li>
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.</li><li>
Satellite, cellular and microwave connection can be used only if approved by leadership.</li><li>
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.</li><li>
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.</li><li>
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.</li></ul>
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. 

$115,200 - $158,400 per year 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, &ldquo;Humana&rdquo;) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-11-2025<h1 class="jobSectionHeader"> 

About us 
</h1>
Humana Inc. (NYSE: HUM) is committed to putting health first &ndash; for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health &ndash; delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. 
 
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.</div>

Vendor Management Lead

<div><h1 class="jobSectionHeader">Become a part of our caring community and help us put health first 
</h1>
The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. 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.<h1 class="jobSectionHeader"> 
Use your skills to make an impact 

</h1>Required Qualifications<ul><li>
Licensed Registered Nurse (RN) in IN (Indiana) with no disciplinary action.</li><li>
3 - 5 years of Medical Surgery, Heart, Lung or Critical Care Nursing experience required</li><li>
Previous experience in utilization management required</li><li>
Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting</li><li>
Comprehensive knowledge of Microsoft Word, Outlook and Excel</li><li>
Ability to work independently under general instructions and with a team</li><li>
Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required</li><li>
Must be passionate about contributing to an organization focused on continuously improving consumer experiences</li></ul>
Preferred Qualifications<ul><li>
3 or more years experience working in a high volume, fast-paced environment with the ability to multi-task</li><li>
Bachelor Degree</li><li>
Health Plan experience</li><li>
Previous Medicare/Medicaid Experience a plus</li><li>
Previous MCG Experience</li><li>
Previous Behavioral Health Experience</li></ul>
Additional Information
Work at Home Guidance
To ensure Home or Hybrid Home/Office associates&rsquo; ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:<ul><li>
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.</li><li>
Satellite, cellular and microwave connection can be used only if approved by leadership.</li><li>
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.</li><li>
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.</li></ul> 
Driver's License, Transportation, Insurance This role is a part of Humana's Driver Safety program and therefore requires and individual to have:<ul><li>
Valid state driver's license</li><li>
Proof of personal vehicle liability insurance with at least $100,000/$300,000/$100,000 limits</li><li>
Access to a reliable vehicle</li></ul> 
Tuberculosis (TB) screening program<ul><li>
This role is considered patient facing and is part of Humana at Home's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.</li></ul> 
Interview Format
As part of our hiring process for this opportunity, we will be using an exciting screening and interviewing technology called Modern Hire to enhance our hiring and decision-making ability. We use this technology to gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
You will be able to respond to the recruiters preferred response method via text, video, or voice technologies. If you are selected for a screen, you may receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication is not missed) inviting you to participate. You should anticipate this screen to take about 15 to 30 minutes. Your recorded screen will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews. 

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. 

$71,100 - $97,800 per year 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, &ldquo;Humana&rdquo;) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.<h1 class="jobSectionHeader"> 
About us 
</h1>
Humana Inc. (NYSE: HUM) is committed to putting health first &ndash; for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health &ndash; delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. 
 
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.</div>

Utilization Management Nurse

<div><h1 class="jobSectionHeader">Become a part of our caring community and help us put health first 
</h1>
The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization. This role involves evaluating complex clinical scenarios and applying evidence-based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors.<h2 class="jobSectionHeader">
Earn a $5,000 hiring bonus! Bonus is paid after 180 days of employment; you must be employed until that date to be eligible to receive the payment.&quot;</h2><h2 class="jobSectionHeader">
Location: Remote &ndash; United States</h2><h2 class="jobSectionHeader">
Schedule:</h2><ul><li>
8-hour shifts, Monday through Friday, between 10:30 AM and 11:00 PM EST 
OR</li><li>
10-hour shifts, Tuesday through Friday, between 10:30 AM and 11:00 PM EST</li><li>
Required to work every 5th Saturday</li><li>
Required to work 1 company holiday per calendar year</li></ul><h2 class="jobSectionHeader">
Job Description:</h2>
The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization, and identifying unusual usage patterns. The pharmacist may intervene and provide clinical guidance to patients and providers to support cost-effective medication use and promote high-quality patient outcomes.<h1 class="jobSectionHeader"> 
Use your skills to make an impact
 
</h1><div></div><div><div><div><div><div><div><div><div><div><h2 class="jobSectionHeader">Required Qualifications:</h2><ul><li>
Bachelor&rsquo;s degree or Doctor of Pharmacy (Pharm.D.) from an accredited college of pharmacy</li><li>
Active pharmacist license in the state of residence</li><li>
Eligibility to participate in federal prescription programs (e.g., Medicare/Medicaid)</li><li>
Self-directed with the ability to work effectively both independently and in a team environment</li><li>
Strong problem-solving skills and the ability to foster collaborative solutions</li><li>
High attention to detail with a strong work ethic focused on accuracy and productivity</li><li>
Excellent verbal and written communication skills</li><li>
Proficiency with computer systems, including but not limited to:<ul><li>
Microsoft Office Suite (Word, Excel, Outlook)</li><li>
Clinical decision support tools (e.g., Micromedex, Lexicomp)</li><li>
Pharmacy benefit management (PBM) platforms</li><li>
Electronic health records (EHRs)</li></ul></li><li>
Passion for contributing to an organization focused on continuously improving the consumer experience</li></ul><h2 class="jobSectionHeader">
Preferred Qualifications:</h2><ul><li>
Experience in managed care pharmacy, particularly in utilization management review</li></ul> 
Additional Information:
Interview Format: As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
WAH Requirements:
To ensure Home or Hybrid Home/Office employees&rsquo; ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: 
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested 
Satellite, cellular and microwave connection can be used only if approved by leadership 
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. 
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. 
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
SSN Statement:
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana&rsquo;s secure website.</div></div></div></div></div></div></div></div></div>
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. 

$94,900 - $130,500 per year 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, &ldquo;Humana&rdquo;) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-08-2025<h1 class="jobSectionHeader"> 

About us 
</h1>
Humana Inc. (NYSE: HUM) is committed to putting health first &ndash; for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health &ndash; delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. 
 
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.</div>

Staff Utilization Management Clinical Pharmacist

<div><h1 class="jobSectionHeader">Become a part of our caring community and help us put health first 
</h1>
The Senior Insurance Product Compliance Professional performs consultation and research for policy and certificate language development. 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 Insurance Product Compliance Professional negotiates with state and federal regulatory agencies to obtain approval of insurance policy and certificate forms; supports implementation and maintenance of compliant insurance product policies and certificates; and begins to influence departmental strategy through subject matter expertise. An associate in this role is expected to make independent decisions on moderately complex to complex technical issues regarding project components; operate with minimal direction, and exercise latitude in determining objectives and approaches to assignments.<h1 class="jobSectionHeader"> 
Use your skills to make an impact 

</h1>Responsibilities<ul><li>
Monitor and analyze state/federal regulatory requirements to assess contract language impacts and provide consultative guidance to other associates within the team. Coordinate legislative updates between Group and Individual products where applicable.</li><li>
Collaborate with various teams regarding state/federal requirements that impact existing products, new products, and product refreshes.</li><li>
Create awareness of current regulatory issues and ensure compliance for new and existing policies, certificates, and other related forms.</li><li>
Write generic and/or state-specific group contract language for Specialty policies/certificates to support product initiatives, administrative practices, and regulatory requirements, including applicable readability standards.</li><li>
Facilitate discussions with operational and compliance partners to review and finalize drafted contract language or assist with negotiating regulatory approvals.</li><li>
Research and develop written responses to or provide consultative support for regulatory objections, exams, and inquiries.</li><li>
Maintain accurate and thorough documentation regarding the rationale for new or revised contract language.</li><li>
Conduct quality reviews of generic and state-specific policy/certificate forms.</li><li>
Serve as Subject Matter Expert (SME) for assigned Specialty lines of business and/or topics, triage and answer compliance related questions regarding policy and certificate language.</li><li>
Assist Professional 2s with drafting state forms and understanding state and federal filing requirements.</li><li>
Work with Professional 2s to ensure information on project tracking tools is accurate and current.</li><li>
When needed, support product filings to include drafting, filing, and implementing production forms, including annual On-Exchange product filings/binders.</li><li>
Recommend and support process improvements to maximize efficiency.</li><li>
Draft or provide input to work instructions/process documentation.</li><li>
In conjunction with the Lead(s), provide training and support to new and existing associates as needed.</li><li>
Write and maintain ASO templates (Plan Management Agreement and Summary Plan Description) for assigned group Specialty product(s).</li><li>
Prepare standard policy and certificate forms for use as templates for state and federal regulatory filings and subsequent implementation.</li><li>
Research and provide responses to Request for Proposals (RFPs) and/or Pre-sale Quotes (PSQs).</li><li>
Consult on application filings issues and coordinate filing of applications for group and/or individual Specialty products.</li><li>
Conduct and/or assist with research requests.</li><li>
All other duties as assigned.</li></ul>
Required Qualifications<ul><li>
Bachelor's Degree or equivalent experience in a healthcare/insurance compliance function</li><li>
Minimum 5 years of healthcare / insurance industry experience</li><li>
Knowledge of laws and regulations governing the healthcare / insurance industry experience, such as state Departments of Insurance and CMS</li><li>
Ability to research and analyze state laws and regulations</li><li>
Understanding of insurance products, including policy/certificate language</li><li>
Proficient in Adobe Acrobat and Microsoft 365 (Office) applications, including Word, Excel, Teams, and SharePoint</li><li>
Excellent oral and written communication skills. This includes ability to collaborate effectively with associates across all levels of the organization and reviewer-level state/federal regulators</li><li>
Demonstrated attention to detail and accuracy</li><li>
Proven analytical and problem solving ability</li><li>
Self-Motivated and task oriented, with an ability to manage multiple priorities and work under pressure to meet deadlines</li><li>
Must be passionate about contributing to an organization focused on ensuring compliance and continuously improving consumer experiences</li></ul>
Preferred Qualifications<ul><li>
Auditing or consulting experience</li><li>
Project coordination or project management experience</li><li>
Experience with filings in System for Electronic Rate and Form Filing (SERFF)</li><li>
Experience with creating and delivering reports and presentations</li></ul>
Additional information
This role is posted remote &ndash; nationwide. Regardless of location, it is expected that this person will work East Coast hours.
SSN Alert Statement 
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana&rsquo;s secure website.
Interview Format 
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
WAH Internet Statement 
To ensure Home or Hybrid Home/Office employees&rsquo; ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested 
Satellite, cellular and microwave connection can be used only if approved by leadership 
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. 
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. 
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. 

$71,100 - $97,800 per year 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, &ldquo;Humana&rdquo;) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-07-2025<h1 class="jobSectionHeader"> 

About us 
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Humana Inc. (NYSE: HUM) is committed to putting health first &ndash; for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health &ndash; delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. 
 
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.</div>

Senior Insurance Product Compliance Professional-Remote

Join Humana and explore 17   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

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