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Humana
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  • Inpatient Medical Coding Auditor  

    - Oklahoma City
    **Become a part of our caring community** The Inpatient Medical Codin... Read More
    **Become a part of our caring community** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. 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. **Use your skills to make an impact** **WORK STYLE:** Remote/work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **WORK HOURS:** Typical business hours are Monday-Friday, 8 hours/day, 5 days/week, scheduled between 6AM-6PM. Some flexibility might be possible, depending on business needs. **Required Qualifications | What it takes to Succeed** - RHIA, RHIT or CCS Certification (should have held at least one of these qualifications for 4 years) - MS-DRG coding/auditing experience - Experience reading and interpreting claims - Experience in performing inpatient coding reviews/ audits in health insurance and/or hospital settings - Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel - Strong attention to detail - Can work independently and determine appropriate course of action - Ability to handle multiple priorities - Capacity to maintain confidentiality - Excellent communication skills both written and verbal **Preferred Qualifications** - Experience in APR DRG coding/auditing - Experience in Financial Recovery - Experience in a fast paced, metric driven operational setting **Additional Information** **Work at Home Requirements** - 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 - Associates 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 associates 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 **Interview Format** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire 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. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice 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, "Humana") 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: 06-11-2026 **About us** 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 - 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website. Read Less
  • Inpatient Medical Coding Auditor  

    - Columbus
    **Become a part of our caring community** The Inpatient Medical Codin... Read More
    **Become a part of our caring community** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. 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. **Use your skills to make an impact** **WORK STYLE:** Remote/work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **WORK HOURS:** Typical business hours are Monday-Friday, 8 hours/day, 5 days/week, scheduled between 6AM-6PM. Some flexibility might be possible, depending on business needs. **Required Qualifications | What it takes to Succeed** - RHIA, RHIT or CCS Certification (should have held at least one of these qualifications for 4 years) - MS-DRG coding/auditing experience - Experience reading and interpreting claims - Experience in performing inpatient coding reviews/ audits in health insurance and/or hospital settings - Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel - Strong attention to detail - Can work independently and determine appropriate course of action - Ability to handle multiple priorities - Capacity to maintain confidentiality - Excellent communication skills both written and verbal **Preferred Qualifications** - Experience in APR DRG coding/auditing - Experience in Financial Recovery - Experience in a fast paced, metric driven operational setting **Additional Information** **Work at Home Requirements** - 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 - Associates 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 associates 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 **Interview Format** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire 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. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice 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, "Humana") 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: 06-11-2026 **About us** 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 - 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website. Read Less
  • Inpatient Medical Coding Auditor  

    - Baton Rouge
    **Become a part of our caring community** The Inpatient Medical Codin... Read More
    **Become a part of our caring community** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. 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. **Use your skills to make an impact** **WORK STYLE:** Remote/work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **WORK HOURS:** Typical business hours are Monday-Friday, 8 hours/day, 5 days/week, scheduled between 6AM-6PM. Some flexibility might be possible, depending on business needs. **Required Qualifications | What it takes to Succeed** - RHIA, RHIT or CCS Certification (should have held at least one of these qualifications for 4 years) - MS-DRG coding/auditing experience - Experience reading and interpreting claims - Experience in performing inpatient coding reviews/ audits in health insurance and/or hospital settings - Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel - Strong attention to detail - Can work independently and determine appropriate course of action - Ability to handle multiple priorities - Capacity to maintain confidentiality - Excellent communication skills both written and verbal **Preferred Qualifications** - Experience in APR DRG coding/auditing - Experience in Financial Recovery - Experience in a fast paced, metric driven operational setting **Additional Information** **Work at Home Requirements** - 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 - Associates 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 associates 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 **Interview Format** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire 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. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice 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, "Humana") 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: 06-11-2026 **About us** 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 - 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website. Read Less
  • Inpatient Medical Coding Auditor  

    - Phoenix
    **Become a part of our caring community** The Inpatient Medical Codin... Read More
    **Become a part of our caring community** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records. The Inpatient Medical Coding Auditor work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and metrics-driven environment. If you are looking to work from home, for a Fortune 100 company that focuses on the well-being of their consumers and staff, and rewards performance, then you should strongly consider the Inpatient Coding Auditor (MSDRG). The Inpatient Medical Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment and appropriate diagnosis related group (DRG) assignments. Analyzes, enters and manipulates database. Responds to or clarifies internal requests for medical information. 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. **Use your skills to make an impact** **WORK STYLE:** Remote/work at home. While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **WORK HOURS:** Typical business hours are Monday-Friday, 8 hours/day, 5 days/week, scheduled between 6AM-6PM. Some flexibility might be possible, depending on business needs. **Required Qualifications | What it takes to Succeed** - RHIA, RHIT or CCS Certification (should have held at least one of these qualifications for 4 years) - MS-DRG coding/auditing experience - Experience reading and interpreting claims - Experience in performing inpatient coding reviews/ audits in health insurance and/or hospital settings - Working knowledge of Microsoft Office Programs Word, PowerPoint, and Excel - Strong attention to detail - Can work independently and determine appropriate course of action - Ability to handle multiple priorities - Capacity to maintain confidentiality - Excellent communication skills both written and verbal **Preferred Qualifications** - Experience in APR DRG coding/auditing - Experience in Financial Recovery - Experience in a fast paced, metric driven operational setting **Additional Information** **Work at Home Requirements** - 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 - Associates 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 associates 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 **Interview Format** As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Hire Vue (formerly Modern Hire) to enhance our hiring and decision-making ability. Hire Vue (formerly Modern Hire 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. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice 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, "Humana") 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: 06-11-2026 **About us** 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 - 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website. Read Less
  • Senior Clinical Policy Research Professional  

    - Boston
    **Become a part of our caring community** The Senior Clinical Policy... Read More
    **Become a part of our caring community** The Senior Clinical Policy Research Professional works closely with Humana's dental directors and medical directors to research, develop and maintain dental and medical coverage policies utilizing an evidence-based medicine review process. Humana is seeking a Senior Clinical Policy Research Professional. In this role you will: + Research and develop dental and medical coverage policies (Medicare and Medicaid) utilizing a standardized checklist and an evidence-based medicine review process as well as utilizing CMS guidance + Provide comprehensive verbal and written summation of research to dental directors, medical directors and leadership during policy discussion meetings and to the MCCR MCPA committees + Perform ad hoc dental and medical research for dental directors and medical directors as needed for individual case reviews + Perform research regarding new CPT and HCPCS codes as needed on a quarterly basis and work closely with the PAL team to address PAL codes requiring clinical coverage policy guidance + Interdepartmental committee participation + Collaboration with stakeholders across the organization Please note this role will consist of working mostly independently to review large amount of clinical information to update clinical policies. **The ideal candidate for this role would enjoy researching, reading and writing policies independently. Success in this role requires:** + Strong organization skills and detail orientation + Excellent verbal and written communication skills + Strong analytical and web navigation skills + Self-direction with demonstrated ability to meet strict deadlines + Strategic thinking and planning capabilities **Use your skills to make an impact** **Required Qualifications** + Associate or bachelor's degree in dental hygiene or dental assisting + Appropriate state certification or licensure as a dental assistant or dental hygienist + 5 years or more of prior clinical experience + Proficiency with Microsoft Office products including Word and Excel **Preferred Qualifications** + Master's degree in health-or business-related field + Utilization management experience (Medicare or Medicaid) + Proven successful experience in compiling health-related research, with associated analysis and conclusions 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. $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, "Humana") 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: 06-04-2026 **About us** 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 - 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website. Read Less
  • Care Coach (Long-Term Services & Support)  

    - Richmond
    **Become a part of our caring community** Humana Healthy Horizons in... Read More
    **Become a part of our caring community** Humana Healthy Horizons in Virginia is looking for Care Coaches who will assess and evaluate members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitating interaction with resources appropriate for the care and wellbeing of members. Work assignments are often straightforward and of moderate complexity. **This role involves meeting members in the field at their home, Nursing Facility (NF) or location of the member's choice, spending quality time assessing their goals, needs and barriers and then connecting our members with quality services to promote their ultimate well-being and drive person centered health outcomes.** + Provides specialized support for Members receiving Long Term Services and Support (LTSS), with a focus on addressing health related social needs (HRSNs), providing psychosocial support, and ensuring LTSS meets the member's service needs. + May support members residing in NFs by building relationships with facility staff, advocating for member care (including access to needed behavioral health services), and assessing the member's desire and ability to return to the community. + Contacts members telephonically and face-to-face to establish goals and priorities, evaluate resources, develop plans of care, and identify LTSS providers and community partnerships to provide a combination of services and supports that best meet the needs and goals of member and caregiver through person centered thinking approaches. + Develops and modifies Individual Service Plan and involve applicable members of the care team in care planning (Informal caregiver coach, PCP, etc.). + Supports members through navigation of their LTSS and related environmental and social needs. + Utilizes available information pertaining to member to prevent the need for administration of duplicative assessments. + Focuses on supporting members and/or caregivers utilizing an interdisciplinary approach in accessing long term services and support, social, housing, educational and other services, regardless of funding sources to meet their needs. + Makes recommendations for appropriate Home and Community-Based Services to enable member's independence in the community. + Facilitates interactions with other payer sources, providers, and Interdisciplinary Care Teams. + Educates members in maintaining Medicaid eligibility. + Assists with entry of annual **Use your skills to make an impact** **Required Qualifications** + **Must reside in the Tidewater region of Virginia or surrounding counties (Hampton, NewPort News, Williamsburg or York)** + Bachelor's degree in health or human services field **OR** an active LPN license in the Commonwealth of Virginia without disciplinary action. + Two (2) years of prior experience in health care and/or case management. + One (1) one year of experience working directly with individuals who meet the Cardinal Care Priority Population criteria _(adults, pediatrics populations at risk for chronic medical conditions & high social needs)_ . + Intermediate to advanced computer skills and experience with Microsoft Word, Excel, and Outlook. + Ability to use a variety of electronic information applications/software programs including electronic medical records. + Exceptional oral and written communication and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders. + Proven ability of critical thinking, organization and problem- solving skills. + This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. + Ability to travel to region-based facilities and homes for face-to-face assessments and interactions with members and/or families. + This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher. **Preferred Qualifications** + Nursing home diversion or long-term care case management experience. + Experience with Medicare & Medicaid recipients. + Experience with electronic case note documentation and documenting in multiple computer applications/systems. + Experience working with complex health population. + Experience with health promotion, coaching and wellness. + Experience working with a Waiver Program. + Knowledge of community health and social service agencies and additional community resources. + Bilingual or Multilingual: English/Spanish, Arabic, Vietnamese, Amharic, Urdu or other - Must be able to speak, read and write in both languages without limitations and assistance. _See "Additional Information" section for more information._ **Additional Information** + **Workstyle:** Field - This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes. + **Travel:** 50 - 75% field interactions with members, and their families and providers. May need to attend onsite meetings occasionally in Humana Healthy Horizons office in Glen Allen, VA. + **Workdays and Hours:** Monday - Friday; 8:00am - 5:00pm Eastern Standard Time (EST). + **Language Assessment Statement:** Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. **WAH Internet Statement** To ensure Home or Hybrid Home/Office employees' 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 required; wireless, wired cable or DSL connection is suggested. + Satellite, cellular and microwave connection can be used only if approved by leadership. + 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. **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. 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. $53,700 - $72,600 per year **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") 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 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 - 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website. Read Less
  • **Become a part of our caring community** At Humana, personalized com... Read More
    **Become a part of our caring community** At Humana, personalized communication is critical to supporting healthier behaviors and building trusted relationships with our consumers. The Customer Engagement Marketing team within Marketing, Regulatory and Operational Communications delivers data‑informed, compliant communications that guide consumers throughout their healthcare journey. Humana is hiring a Senior Associate role to support high‑impact communication initiatives across billing and enrollment. Reporting to an Associate Director, this role partners cross‑functionally to plan, develop, and execute operational and regulatory communications that support onboarding, education, engagement, medication adherence, and retention. This position is ideal for an experienced professional who thrives in fast‑paced, collaborative environments and is passionate about delivering clear, empathetic, and timely communications that improve consumer experience. Key Responsibilities + Lead cross‑functional delivery across design, build, testing, and deployment, keeping business, IT, compliance, legal, analytics, and operations aligned. + Plan and manage timelines, dependencies, and milestones; proactively identify and resolve risks or blockers. + Partner with subject‑matter experts to clarify requirements, refine solutions, and incorporate feedback through demos and reviews. + Produce and maintain high‑quality delivery documentation, including requirements, workflows, acceptance criteria, and solution guides. + Own testing and validation activities to ensure solutions meet quality, compliance, and performance expectations before and after launch. + Support Agile execution by prioritizing work, contributing to sprint planning, backlog refinement, and progress tracking. + Collaborate with developers and content production teams to ensure scalable, stable, and on‑time delivery. + Perform small, less complicated content updates within SmartComm, or OpenText, to allow content developers to focus on larger change requests/initiatives. + Identify opportunities to improve communication quality, workflows, systems, and operational efficiency through simplification and automation. **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree in Marketing, Information Technology, or a related field, or four (4) years of equivalent professional experience. + 3+ years of professional experience in communications, marketing, project management, IT, or a related role involving technical requirements, system builds, or testing. + 3+ years of experience writing requirements or user stories and translating business needs into technical solutions. + 2+ years of experience working with data used in customer communications, including data mapping, field validation, and dynamic or personalized messaging. + 2+ years of experience leading or influencing cross‑functional technical projects and driving timelines and deliverables without direct authority. + 2+ years of experience identifying and implementing measurable process or workflow improvements (e.g., reduced defects, faster cycle time, improved accuracy). **Preferred Qualifications** + Billing and Enrollment Experience preferably in healthcare + Previous healthcare experience + Prior exposure to CMS model language + Proficient with MS Office Word, Excel, PowerPoint + Familiar with mainframe data files + Communication delivery method - knowledge of print, web and email processes + PMP, Lean or Six Sigma certification 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, "Humana") 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: 06-05-2026 **About us** 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 - 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website. Read Less
  • Associate Director, Incident Management Practice  

    - Louisville
    **Become a part of our caring community** The Associate Director, Inc... Read More
    **Become a part of our caring community** The Associate Director, Incident Management Practice (Service Offerings Management) leads the strategy, design, governance, and maturity of Humana's enterprise Incident Management capabilities in the Service Operations Organization. You will lead the Incident Management practice end to end including standards, tooling, metrics, workforce capability, and continuous improvement ensuring consistent, predictable, and scalable incident response across all technology domains. **Incident Management Practice Leadership** + Lead the Incident Management Practice, establishing a clear vision, operating model, and roadmap for enterprise adoption. + Define practice standards, policies, strategies and governance models to ensure execution across teams. + Be an authoritative owner for Incident Management capabilities, frameworks, and methodologies. + Develop a multi-year practice maturity roadmap, aligned with Humana's priorities and digital transformation goals. + Lead the ServiceNow Incident Management Practice and guide ServiceNow maturity through automation, AI‑driven insights, self‑healing workflows, and advanced reporting. + Ensure vendors and suppliers align with enterprise Incident Management practice standards. **Enterprise Incident & Major Incident Governance** + Govern incident priority models, escalation frameworks, and executive communication standards. + Oversee Incident Management governance in partnership with the 6 Incident sub‑process owners and teams. + Ensure reliable, repeatable execution of incident response practices across platforms and teams. **AI Enablement & Intelligent Operations** + Champion the integration of AI and AIOps capabilities into the Incident Management Practice. Increase adoption of AI‑assisted detection, correlation, triage, prioritization, and root‑cause analysis. + Partner with data, automation, and platform teams to shift from reactive to predictive and preventative incident management. **Process Development & Governance** + Ensure understanding of ITIL(Information Technology Infrastructure Library) and organizational risk, compliance, and audit requirements. + Lead governance forums and Incident Practice meetings to manage policy adherence and continuous improvement. **People, Capability & Community Leadership** + Lead a team of Incident Management Practice subject matter experts. + Mature enterprise‑wide capability through training, coaching, and practice enablement. + Lead the Incident Management community of practice to share knowledge, lessons learned, and innovations. **Performance Metrics, Analytics & Insights** + Ensure enterprise KPIs and standard metrics for incident response, availability and customer experience. + Use analytics and AI insights to identify trends, systemic risks, and improvement opportunities. + Deliver executive‑level dashboards, insights, and recommendations. **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree in computer science, information technology, engineering, or a related discipline. + 10+ years of progressive IT experience within Service Management, Operations, or Reliability Engineering. + 5+ years of leadership experience in IT. + Expertise in Incident Management, Major Incident Management, and Service Desk Management in complex enterprises. + Working knowledge of ITIL frameworks and service governance models. + Demonstrated experience leading teams through transformation and operating model change. + Experience using data, analytics, and automation to improve operational outcomes. + Proven experience delivering clear, confident, and effective communication to senior leadership and key stakeholders. + Strategic thinker with the ability to align operational practices to business and customer outcomes. **Preferred Qualifications** + Advanced degree (MBA, MS) or relevant certifications such as ITIL Managing Professional, PMP, ServiceNow certifications, or SRE training. + Hands‑on experience implementing AI‑enabled IT operations (AIOps), intelligent alerting, or predictive incident solutions. + Experience serving as platform owner or executive sponsor for ServiceNow or similar enterprise ITSM platforms. + Background in regulated, healthcare, financial services, or global enterprise environments. + Experience leading automation, self‑healing, or shift‑left initiatives. **Additional Information** + **Preferred Location and Workstyle:** _We ideally base this role in_ **_Dallas (Frisco), Texas or Louisville, Kentucky_** _, and_ **_prefer a hybrid work arrangement_** _for candidates located in or near these markets._ We may consider fully remote candidates as a secondary option, evaluating them based on experience, leadership capability, and agreement on organizational needs. + **Direct Reports:** Up to 10 associates. **WAH Internet Statement** To ensure Home or Hybrid Home/Office employees' 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 required; 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. **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. **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. $129,300 - $177,800 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, "Humana") 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 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 - 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website. Read Less
  • UM BH Registered Nurse  

    - Madison
    **Become a part of our caring community** Are you a transitioning mil... Read More
    **Become a part of our caring community** Are you a transitioning military service member or a military spouse looking for an internship that supports the goal to put health first? The DOW SkillBridge Internship and Military Spouse Fellowship Programs will provide you with main training to perform your internship. You will partner with your team to support members, projects, and to meet goals affecting outcomes. The professionals you work with at Humana will depend on the type of internship you select. They may include healthcare professionals, HR, and IT, to name a few. The objective is to support and facilitate care for members. To be eligible for this internship, you must either be a transitioning military service member or a military spouse, and you must obtain eligibility to participate in these DOW sponsored programs. The Utilization Management Behavioral Health Registered Nurse (RN) Intern will report to a manager of the National Medicaid team. You will use training and engage formerly acquired skillsets to complete medical necessity reviews for behavioral health requested services using clinical judgment and provides referrals to internal stakeholders for further review depending on case findings. **You will participate in the following assignments in this role:** **Clinical Review:** + Conduct comprehensive clinical reviews of prior authorization requests to determine medical necessity and benefit eligibility. + Apply advanced evidence-based clinical guidelines in review decisions. + Ensure compliance with accreditation, state, and federal regulations. **Communication and Coordination:** + Communicate with healthcare providers to obtain necessary clinical information and clarify requests. + Coordinate with medical directors and interdisciplinary teams to support decision-making. + Promote communication between clinicians, internal departments, and members. **Documentation and Reporting:** + Document all review findings and decisions in clinical documentation systems. + Ensure timely and accurate documentation of prior authorization determinations. + Support reporting programs and provide data for performance improvement projects. **Quality Assurance:** + Implement quality assurance measures to ensure accuracy and consistency in prior authorization decisions. + Conduct regular audits and reviews to maintain high standards of service. + Identify process improvement opportunities and contribute to performance improvement projects. **Education and Training** : + Educate providers and staff on prior authorization policies, criteria, and review processes. + Provide mentorship and feedback to nonclinical staff and peers to enhance workflow efficiency. + Stay current with clinical best practices and regulatory changes. **Use your skills to make an impact** **Required Qualifications:** + **You must be a transitioning service member eligible to participate in the DOW SkillBridge or a military spouse eligible to participate in the military spouse fellowship** · + Active Registered Nurse, RN, in the state of Kentucky or an enhanced Compact, (eNLC) license without restrictions or disciplinary action.· + **Minimum two, (2) years of clinical behavioral health experience.** + Proficiency in healthcare software and electronic medical records (EMR) systems. + Have an interest in working in the managed care industry. **Preferred Qualifications:** + Bachelor's degree + Previous Medicare/Medicaid experience. + Previous experience in prior authorization, utilization management. + Experience working with MCG or Interqual guidelines. + Certification in Case Management, (CCM) or Utilization Review, (UR). + Knowledge of payer policies, insurance companies and government health programs. **Workstyle:** Remote Work at Home **Location:** Must reside in a state that participates in the enhanced compact license, (eNLC) **Work Schedule:** Weekdays 8:00 AM to 4:30 PM Central Time **Travel:** None **Additional Information** **Work At Home Requirements** + 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. + A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. + Satellite and Wireless Internet service is NOT allowed for this role. + A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **The DOW SkillBridge Internship Program** provides transitioning military service members time to gain civilian work experience while still on active duty with an employer for a period approved by their command and the DOW, with an average timeline of 90 days. **The Military Spouse Fellowship Program** connects military spouses with employers offering a variety of professional onsite, field, or remote based opportunities for a period up to 12 weeks. + Networking opportunities will be provided while participating in the Internship or Fellowship. + Due to factors such as location, and/or requirements that cannot be modified, full-time employment is not guaranteed upon completion of the Internship or Fellowship. **Interview Format** As part of our hiring process, we will be using a screening and interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring leaders with an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. **(please be sure to check your spam or junk folders often to ensure communication isn't missed)** **SSN Alert** 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's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 1 **About us** 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 - 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website. Read Less
  • UM BH Registered Nurse  

    - Denver
    **Become a part of our caring community** Are you a transitioning mil... Read More
    **Become a part of our caring community** Are you a transitioning military service member or a military spouse looking for an internship that supports the goal to put health first? The DOW SkillBridge Internship and Military Spouse Fellowship Programs will provide you with main training to perform your internship. You will partner with your team to support members, projects, and to meet goals affecting outcomes. The professionals you work with at Humana will depend on the type of internship you select. They may include healthcare professionals, HR, and IT, to name a few. The objective is to support and facilitate care for members. To be eligible for this internship, you must either be a transitioning military service member or a military spouse, and you must obtain eligibility to participate in these DOW sponsored programs. The Utilization Management Behavioral Health Registered Nurse (RN) Intern will report to a manager of the National Medicaid team. You will use training and engage formerly acquired skillsets to complete medical necessity reviews for behavioral health requested services using clinical judgment and provides referrals to internal stakeholders for further review depending on case findings. **You will participate in the following assignments in this role:** **Clinical Review:** + Conduct comprehensive clinical reviews of prior authorization requests to determine medical necessity and benefit eligibility. + Apply advanced evidence-based clinical guidelines in review decisions. + Ensure compliance with accreditation, state, and federal regulations. **Communication and Coordination:** + Communicate with healthcare providers to obtain necessary clinical information and clarify requests. + Coordinate with medical directors and interdisciplinary teams to support decision-making. + Promote communication between clinicians, internal departments, and members. **Documentation and Reporting:** + Document all review findings and decisions in clinical documentation systems. + Ensure timely and accurate documentation of prior authorization determinations. + Support reporting programs and provide data for performance improvement projects. **Quality Assurance:** + Implement quality assurance measures to ensure accuracy and consistency in prior authorization decisions. + Conduct regular audits and reviews to maintain high standards of service. + Identify process improvement opportunities and contribute to performance improvement projects. **Education and Training** : + Educate providers and staff on prior authorization policies, criteria, and review processes. + Provide mentorship and feedback to nonclinical staff and peers to enhance workflow efficiency. + Stay current with clinical best practices and regulatory changes. **Use your skills to make an impact** **Required Qualifications:** + **You must be a transitioning service member eligible to participate in the DOW SkillBridge or a military spouse eligible to participate in the military spouse fellowship** · + Active Registered Nurse, RN, in the state of Kentucky or an enhanced Compact, (eNLC) license without restrictions or disciplinary action.· + **Minimum two, (2) years of clinical behavioral health experience.** + Proficiency in healthcare software and electronic medical records (EMR) systems. + Have an interest in working in the managed care industry. **Preferred Qualifications:** + Bachelor's degree + Previous Medicare/Medicaid experience. + Previous experience in prior authorization, utilization management. + Experience working with MCG or Interqual guidelines. + Certification in Case Management, (CCM) or Utilization Review, (UR). + Knowledge of payer policies, insurance companies and government health programs. **Workstyle:** Remote Work at Home **Location:** Must reside in a state that participates in the enhanced compact license, (eNLC) **Work Schedule:** Weekdays 8:00 AM to 4:30 PM Central Time **Travel:** None **Additional Information** **Work At Home Requirements** + 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. + A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. + Satellite and Wireless Internet service is NOT allowed for this role. + A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information **The DOW SkillBridge Internship Program** provides transitioning military service members time to gain civilian work experience while still on active duty with an employer for a period approved by their command and the DOW, with an average timeline of 90 days. **The Military Spouse Fellowship Program** connects military spouses with employers offering a variety of professional onsite, field, or remote based opportunities for a period up to 12 weeks. + Networking opportunities will be provided while participating in the Internship or Fellowship. + Due to factors such as location, and/or requirements that cannot be modified, full-time employment is not guaranteed upon completion of the Internship or Fellowship. **Interview Format** As part of our hiring process, we will be using a screening and interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring leaders with an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. **(please be sure to check your spam or junk folders often to ensure communication isn't missed)** **SSN Alert** 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's secure website. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 1 **About us** 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 - 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. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website. Read Less

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