Humana

The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following guidelines, and approves services or forwards requests to the appropriate stakeholder. This role involves completing medical necessity and level of care reviews using clinical judgment and educating providers on utilization and medical management processes.

The Nurse Auditor 2 conducts clinical audit and validation processes to ensure medical record documentation and coding for services rendered are complete, compliant, and accurate to support optimal reimbursement. This role involves validating and interpreting medical documentation, applying clinical and coding experience to review provider codes and billing, and making decisions on clinical appropriateness.

This role is responsible for leading the strategic direction for Cost Transparency across infrastructure and cloud services, developing frameworks for service economics, and driving a culture of financial accountability. Key duties also involve leading enterprise-wide initiatives to improve infrastructure productivity, such as asset utilization analysis and service rationalization.

The representative acts as a member of the Provider Concierge team, handling inbound calls and making outbound contacts to providers regarding various issues while offering a "white glove" experience. This role involves performing necessary follow-up with members and/or providers to ensure timely responses that meet service and quality standards.

The Senior Data Engineer designs, builds, and maintains data processing architectures to convert structured and unstructured data into enterprise-scale insights. This involves ingesting data using cloud-native platforms and developing software tools leveraging AI/ML and big-data techniques for data transformation.

The Principal Designer will own and evolve the enterprise design system's architecture, defining best practices for collaboration between design and engineering, especially concerning generative AI workflows. This role involves tracking success metrics and ensuring the system transforms into a technically robust platform with deep integration into front-end engineering.

The Field Care Manager acts as the primary point of contact, providing integrated care through personalized coordination, crisis intervention, and collaboration with providers to ensure members receive timely, high-quality services. Responsibilities include driving the interdisciplinary care team, managing care planning, facilitating meetings, and linking members to appropriate community services while ensuring regulatory compliance.

The Lead Data Engineer will design, build, and optimize cloud-native data pipelines and platform components, ensuring high performance, reliability, and scalability. Key tasks include serving as a technical expert for Snowflake and Azure, leading hands-on implementation, developing API-driven integrations using MuleSoft, and driving migration from on-prem SQL Server to Snowflake.

Key responsibilities include analyzing financial, utilization, and performance data to identify quality improvement opportunities and cost reductions, as well as designing and developing ROI analyses for new Value Based Payment models using various healthcare data sources. The role also involves collaborating with cross-functional teams to operationalize and monitor new VBP models, ensuring data integrity throughout the process.

Full Stack Software Engineer developing applications using GraphQL and React.