Qureos Mentor

Humana

<div><h1 class="jobSectionHeader">Become a part of our caring community 
</h1>
Humana Healthy Horizons in Florida is seeking a UM Administration Coordinator who will contribute to the administration of utilization management. The UM Administration Coordinator performs advanced administrative/operational/customer support duties that require independent initiative and judgment and will report to the Supervisor, UM Admin coordinators.
The UM Administration Coordinator:<ul><li>
Provides non-clinical support for the policies and procedures ensuring best and most appropriate treatment, care or services for members.</li><li>
Decisions are typically focused on methods, tactics and processes for completing administrative tasks/projects.</li><li>
Regularly utilizes judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques.</li><li>
Works utilizing previous experience and depth of knowledge of administrative processes and organizational knowledge.</li></ul><h1 class="jobSectionHeader"> 

Use your skills to make an impact 

</h1>Required Qualifications<ul><li>
2 or more years of administrative or technical support experience.</li><li>
Proficiency utilizing Windows based environment &amp; open to learning new systems.</li><li>
Experience utilizing electronic medical record and/or documentation programs.</li><li>
ACHA Level II Background Check is required.</li></ul>
Preferred Qualifications<ul><li>
Prior member service or customer service telephone experience.</li><li>
Proficiency and/or experience with medical terminology and/or ICD-10 codes.</li><li>
Experience with Utilization Review and/or Prior Authorization within a managed care organization.</li></ul>
Additional Information:<ul><li>
Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.</li><li>
Work Location: must reside in the state of Florida.</li><li>
Typical work days/hours: Monday &ndash; Friday, 8:30 am &ndash; 5:00 PM EST</li></ul>
WAH Internet Statement
To ensure Home or Hybrid Home/Office employees', 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 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>
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>
HireVue
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring. 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.
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. 

$40,000 - $52,300 per year 
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>
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. 
 
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>

UM Administration Coordinator 2

<div><h1 class="jobSectionHeader">Become a part of our caring community 
</h1>
Within the Enterprise Associate and Business Solutions organization of the Chief Administration Office, the Humana Safety and Security team is responsible for associate safety, facility physical security and environmental health across the Humana enterprise. The combined efforts of the safety and security professionals, and our trusted strategic vendors, provide a professional and safe work environment for our associates and a friendly service atmosphere for our members. In an ever-changing environment, it is necessary to manage the risk to our associate population whether that be during routine meeting attendance, travel, and other ad hoc events. Unlike traditional executive protection, we take a concierge approach to our services provided, measuring customer service as a key driver.
The individual selected for this role will serve as a Senior Security Professional and report to the Associate Director of the Humana Safety and Security Executive Support Team. This role calls for an individual that can operate independently, is comfortable making decisions based on an understanding of the leader&rsquo;s intent, is detailed-oriented and can execute established protocols in demanding situations or exercise good judgement where protocols do not exist. This role requires an individual capable of interacting with leaders at all levels. Flexibility is necessary to be successful in this demanding role as short notice travel and weekend commitments are not unusual.
An individual should expect to do many of the following in each day:<ul><li>
Conduct threat, risk and vulnerability assessments ahead of planned events or travel; develop cost-effective countermeasures and other risk mitigations to fill identified gaps</li><li>
Liaise with physical security team and/or security contractors to ensure appropriate security measures and technology are available for deployment</li><li>
Investigate threats to associates; identify and implement safeguards to ensure associate safety</li><li>
Coordinate with external hotel/meeting or other venue security; to ensure tailored risk mitigation deployment</li><li>
Provide transportation to senior leaders</li><li>
Coordinate use and care of fleet vehicles in support of transportation requirements</li><li>
Consult with partners throughout the enterprise to ensure logistical requirements are addressed</li><li>
Regularly coordinate with Executive Assistants to understand/support planned travel</li><li>
Support business leaders in the absence of other administrative support</li><li>
Provide routine updates to supervisor and Humana Fusion Center to ensure situational awareness within the organization</li><li>
Consult with facilities and project managers during construction to ensure safety/security considerations are addressed</li><li>
Contribute to the development/refinement of standard operating procedures associated with travel and event planning and execution</li><li>
Establish and maintain relationships with maintenance and security vendors at select sites to include principle&rsquo;s residence</li><li>
Provide close protection of executive members including developing, assessing, and implementing protection strategies and plans</li><li>
Provide guidance and interpretation about security standards, practices, and programs to support regional and global business and security initiatives</li><li>
Partake in continuous Executive Protection training</li><li>
Maintains liaison with government, industry, and intelligence professionals</li><li>
Brief Executives on geopolitical developments, incidents and trends that could affect Humana Inc. business and personnel</li><li>
Traveling nationwide and internationally, with frequent overnight and weekend travel, as necessary</li></ul>
A successful Candidate would:<ul><li>
Be a poised leader and collaborator who gains support from all levels of the organization, including senior executives</li><li>
Demonstrate confidentiality with sound, ethical judgment and integrity</li><li>
Possess strong leadership skills to include coaching, mentoring, and educating</li><li>
Have the superior ability to use security systems and applications</li><li>
Have excellent analytical skills with the ability to identify complex security issues and customize, implement/execute innovative processes and solutions</li><li>
 Demonstrate the ability to perform under pressure in complex situations</li><li>
 Have proven &quot;customer service&quot; and relationship management skills</li><li>
 Demonstrate project management skills, including planning, execution, and implementation</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>
Demonstrated Corporate and/or government experience interacting with and supporting senior leaders (C-Suite) and other VIPs</li><li>
5+ years of previous military, law enforcement or executive/personal security experience</li><li>
5+ years of security experience, including backgrounds in law enforcement, military, intelligence, and/or corporate environments, with demonstrated experience in small team/detail leadership, event security, and budget management.</li><li>
Support approximately 35% travel and weekend support based on business need</li></ul>
Preferred Qualifications<ul><li>
Advanced Life Support Certified</li><li>
Certified Protection Professional (CPP)</li></ul>
Additional information:
This role is Office (5 days/week) when not on travel.
In this role you will report to an Associate Director.
This role is an individual contributor without any managerial responsibilities. 
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. 

$86,300 - $118,700 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>
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. 
 
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 Security Professional; Executive Support

<div><h1 class="jobSectionHeader">Become a part of our caring community 
</h1>
The Senior Insider Threat Hunter is a technical subject matter expert for the threat hunting team for Humana systems. This role works closely with EIP's Threat Management and Response teams as well as other enterprise information security teams and will report to Associate Director.
The Senior, Insider Threat Hunter analyzes complex information systems to understand associated cybersecurity risks and provide proactive identification of security events. Works closely with EIP's SIEM functionality to conduct hypothesis-driven threat hunts, detect suspicious activity, and support the identification and investigation of potential security incidents.
Partners with SOC and incident response teams to validate findings, document outcomes, and recommend improvements to monitoring coverage and investigative processes. Contributes to insider threat monitoring by identifying anomalous user behavior, credential misuse, and suspicious data access or movement patterns, escalating concerns through appropriate channels.
Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under general direction, using judgment to evaluate variable factors and determine the best course of action within established procedures.
Skills/Expertise<ul><li>
Develop custom tools and leverage automation and orchestration for threat hunting, malware research and threat intelligence needs.</li><li>
Creation and maintenance of policy, standards, procedures, and documentation</li><li>
Use KPIs and other metrics to identify opportunities for process improvements.</li><li>
Experience working under and providing support for regulatory frameworks such as HIPAA, PCI, SOC2, etc.</li></ul><h1 class="jobSectionHeader"> 

Use your skills to make an impact 

</h1>Required Qualifications<ul><li>
Bachelor's degree in Cybersecurity, Information Technology or a related field is preferred.</li><li>
Minimum of 4 years' experience with threat hunting, threat research, threat intelligence or incident response.</li><li>
Expert level understanding of the threat landscape in terms of the tools, tactics and techniques of threats and a strong understanding of how complex, multi-stage malware functions.</li><li>
Advanced knowledge of security endpoint detection and response, network forensics and malware analysis across systems whether on premise or in varied cloud environments consisting of physical or virtual workloads.</li></ul>
Preferred Qualifications<ul><li>
Professional certification in a relevant cybersecurity field (i.e., OSCP, GCTI, GREM, etc)</li><li>
AI/python scripting/automation</li></ul>
Remote/WAH requirements:<ul><li>
WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.</li><li>
A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.</li><li>
Satellite and Wireless Internet service is NOT allowed for this role.</li><li>
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. 

$117,600 - $161,700 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: 04-08-2026<h1 class="jobSectionHeader"> 

About us 
</h1>
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. 
 
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 Insider Threat Hunter

<div><h1 class="jobSectionHeader">Become a part of our caring community 
</h1>
The Internal Audit Consulting Group drives the achievement of Humana&rsquo;s strategic and financial objectives. The Senior Internal Auditor provides value-added service by evaluating the efficiency and effectiveness of Humana&rsquo;s operational processes.<div><div><div>
Job Description</div></div><div><div><div><div><div><div><div><div><div>
As a Senior IT Audit Professional, you will play a critical role in assessing and strengthening Humana's cybersecurity, technology governance, and emerging technology risks. You will operate within a large, diverse, and technically challenging enterprise environment, evaluating complex systems, distributed architectures, and rapidly evolving technologies while helping ensure that controls are designed effectively, operating as intended, and aligned with Humana's policy and strategic objectives.</div></div></div></div></div></div></div></div></div></div><div> 
 In this role:</div><div><ul><li>
Perform IT audit and cybersecurity-focused consulting engagements, evaluating application, infrastructure, and cloud environments following established audit methodology and within budgeted timeframes.</li><li>
Execute IT audit procedures, including planning, walkthroughs, control testing, data analysis, and documentation of results in complex environments requiring significant technical judgment.</li><li>
Apply professional IT audit concepts, cybersecurity frameworks (e.g., NIST CSF), and established technologies while consistently using standard audit techniques such as control testing, data analysis, and risk assessment.</li><li>
Review, analyze, and interpret IT, security, and operational data to identify control gaps, technology risks, and vulnerabilities within Humana's governance, risk, and control environment with a primary focus on cybersecurity and technology operations.</li><li>
Audit and evaluate cybersecurity controls across a large and intricate technology landscape, spanning cloud platforms, identity and access management systems, distributed infrastructure, network architectures, and enterprise applications.</li><li>
Assess emerging risks, including those related to AI/ML technologies, cloud transformation, identity modernization, data governance, and evolving threat vectors.</li><li>
Identify control weaknesses, cybersecurity vulnerabilities, misconfigurations, and root causes, and prepare clear, actionable draft audit issues that reflect impact, likelihood, and risk alignment.</li><li>
Ensure risks are mitigated by recommending security-focused improvements.</li><li>
Clearly and concisely communicate the results of IT audit and cybersecurity engagements through written reports and presentations to management, translating technical risks into business relevant impact.</li><li>
Prepare and communicate clear, concise, and risk-focused audit reports and recommendations for management, translating deep technical issues into business relevant insights.</li><li>
You will leverage AI and automation tools to improve audit risk assessment, testing and document process improvements for department-wide adoption.</li></ul></div><h1 class="jobSectionHeader"> 
Use your skills to make an impact 

</h1><div><div>In this role, you will:<ul><li>
Perform IT audit and cybersecurity-focused consulting engagements, evaluating application, infrastructure, and cloud environments following established audit methodology and within budgeted timeframes.</li><li>
Execute IT audit procedures, including planning, walkthroughs, control testing, data analysis, and documentation of results in complex environments requiring significant technical judgment.</li><li>
Apply professional IT audit concepts, cybersecurity frameworks (e.g., NIST CSF), and established technologies while consistently using standard audit techniques such as control testing, data analysis, and risk assessment.</li><li>
Review, analyze, and interpret IT, security, and operational data to identify control gaps, technology risks, and vulnerabilities within Humana's governance, risk, and control environment with a primary focus on cybersecurity and technology operations.</li><li>
Audit and evaluate cybersecurity controls across a large and intricate technology landscape, spanning cloud platforms, identity and access management systems, distributed infrastructure, network architectures, and enterprise applications.</li><li>
Assess emerging risks, including those related to AI/ML technologies, cloud transformation, identity modernization, data governance, and evolving threat vectors.</li><li>
Identify control weaknesses, cybersecurity vulnerabilities, misconfigurations, and root causes, and prepare clear, actionable draft audit issues that reflect impact, likelihood, and risk alignment.</li><li>
Ensure risks are mitigated by recommending security-focused improvements.</li><li>
Clearly and concisely communicate the results of IT audit and cybersecurity engagements through written reports and presentations to management, translating technical risks into business relevant impact.</li><li>
Prepare and communicate clear, concise, and risk-focused audit reports and recommendations for management, translating deep technical issues into business relevant insights.</li><li>
You will leverage AI and automation tools to improve audit risk assessment, testing and document process improvements for department-wide adoption.</li></ul>
Required Qualifications<ul><li>
Bachelor's degree in computer science, Information Systems, or related field.</li><li>
At least 3 years of IT risk audit or consulting experience, or IT experience focusing on systems operations, software development, cybersecurity, cloud, AI, or infrastructure.</li><li>
Certification relative to IT audit such as CISA, CISM, or CISSP are preferred. A certification is required for promotion to leadership.</li><li>
IT risk or assurance audit experience required</li><li>
Foundational knowledge of AI concepts, risks, and controls, including understanding how AI/ML models impact data integrity, security, and governance.</li><li>
Ability to evaluate AI-enabled systems, including assessing algorithmic transparency, data quality, model monitoring, and emerging AI cybersecurity risks enabled systems, including assessing algorithmic transparency, data quality, model monitoring, and emerging AI cybersecurity risks.</li><li>
Successful track record in facilitating and consulting across teams and managing projects.</li><li>
Excellent organizational skills and attention to detail.</li><li>
Must be team-oriented and maintain‑oriented and maintain an optimistic, collaborative attitude.</li><li>
Must demonstrate the ability to manage multiple or competing priorities effectively.</li><li>
Must exhibit excellent communication skills, both oral and written.</li><li>
The candidate must possess strong implementation and execution capabilities, along with well-developed critical thinking skills.</li><li>
The candidate must have an aptitude for building effective working relationships with associates across the department and the broader business.</li><li>
Must be passionate about contributing to an organization focused on continuously improving consumer experiences.</li><li>
You will be asked to be a self-starter with the ability to work independently and with minimal supervision.</li></ul></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: 04-04-2026<h1 class="jobSectionHeader"> 

About us 
</h1>
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. 
 
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 IT Auditor

<div><h1 class="jobSectionHeader">Become a part of our caring community 
</h1>
Job Description Summary 
The Regional VP, Health Services relies on medical background to create and oversee clinical strategy for the region. The Regional VP, Health Services requires an in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide.
Regional VP of Health Services, Humana Medicare Advantage
As the Regional VP of Health Services, you will serve as the senior clinical executive responsible for shaping and executing the region&rsquo;s clinical engagement strategy. This role drives quality improvement, cost efficiency, and population health outcomes through strategic provider partnerships, data-informed decision-making, and cross-functional collaboration. The RVP acts as a key advisor, innovator, and relationship builder, ensuring alignment with Humana&rsquo;s mission and Medicare Advantage goals.
Primary Responsibilities:
Clinical Engagement &amp; Provider Strategy:<ul><li>
Cultivate and maintain trusted relationships with CMOs and senior executive/clinical leaders at provider and care delivery partner organizations. First and foremost, this is a role focused on building relationships with providers, and then leveraging those relationships to collaborate on how to positively drive provider performance, overcome operational barriers and reduce administrative burden.</li><li>
Serve as lead clinical executive for provider groups, translating clinical and quality priorities into actionable strategies. This includes promoting growth strategies and innovation with all provider groups, particularly our CenterWell partners.</li><li>
Enhance innovation with hospital systems while fostering collaboration and reducing operational barriers.</li><li>
Drive population health initiatives to improve the health and well-being of our members including:<ul><li>
A strong understanding of clinical metrics and data (e.g. Quality measures, Risk Adjustment ratings, chronic condition management, PCP visit rates and effectiveness, and member engagement strategies).</li><li>
Identifying and implementing initiatives to address total cost of care drivers.</li><li>
Championing condition-based interventions.</li><li>
Leading clinical strategies to manage unique populations, such as unattributed membership, low income, disabled, or special needs members.</li></ul></li></ul>
Clinical Strategy &amp; Market Performance:<ul><li>
Serve as the clinical steward for regional medical expense trends, leveraging data to guide interventions, and ensure fiscal accountability.</li><li>
Collaborate with finance, analytics, and market leadership to identify cost and quality outliers and implement targeted action plans.</li><li>
Customize strategies to align clinical programs with payer-specific needs (MA, D-SNP).</li><li>
Provide clinical input into network development, contract negotiations, and delegation oversight.</li><li>
Serve as clinical subject matter for potential plan design and clinical programs to support continued health plan growth.</li><li>
Represent the organization in regional health coalitions and community health initiatives.</li><li>
Collaborate with various operational functions in the centralized utilization management team and other shared services.</li><li>
Participate in quality governance, peer review, and grievance resolution processes.</li></ul>
Innovation &amp; Transformation:<ul><li>
Partner with national innovation teams to pilot and scale emerging technologies and care models (e.g., remote monitoring, clinical pathways, tech-enabled care).</li><li>
Lead regional implementation of clinical focused strategic programs.</li><li>
Collaborate with vendor partnerships and evaluate performance against clinical and financial KPIs.</li><li>
May also be involved in governance committees and delegation oversight.</li></ul><h1 class="jobSectionHeader"> 
Use your skills to make an impact 

</h1>Qualifications:<ul><li>
Active MD or DO licensure with appropriate training and certification</li><li>
5+ years clinical practice</li><li>
5 + years in managed care industry, either provider or payer.</li><li>
Thorough knowledge of health care utilization and quality metrics and the impact value-based contracting has on provider behavior and performance.</li><li>
The ability to quickly monitor clinical metrics and convey the impact verbally and in writing.</li><li>
Proficient communication skills, including interpersonal, written and presentation, and the ability to promote complex material in a way that can be understood and acted upon by others.</li><li>
Strategic thinker with the ability to balance long-term vision and short-term execution.</li><li>
Established track record of building successful teams and cross departmental relationships</li><li>
Travel required 25-30%</li><li>
Reside within and willing to travel within the region&rsquo;s geographic boundaries to include VA, NC, SC, and GA</li></ul>
Preferred:<ul><li>
Experience in both provider and payer roles</li><li>
Prior executive level role with successful track record of building external relationships and driving quality and financial results in a collaborative team/matrixed environment</li><li>
Advanced degree in business, management and/or population health.</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. 

$327,700 - $450,600 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>
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. 
 
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>

Regional Vice President, Health Services Southeast Region

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UM Administration Coordinator 2

Senior Security Professional; Executive Support

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Senior IT Auditor

Regional Vice President, Health Services Southeast Region

Regional Vice President, Health Services Southeast Region

Regional Vice President, Health Services Southeast Region