[Hiring] In Home Eligibility Lead @Humana

Role Description The Program Delivery Lead strategically identifies, develops, and implements programs that influence providers, members or market leadership towards value-based relationships and/or improved quality metrics. The Program Delivery Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The IHWA In‑Home Eligibility Lead is responsible for overseeing and managing eligibility strategy, execution, and data integrity for in‑home Quality Focused Visit (QFV) and related IHWA vendor programs. This role ensures:

• Accurate member targeting
• Consistent eligibility logic
• Timely file delivery across multiple vendor partners

This supports high‑quality execution, Stars outcomes, and operational scalability. The Eligibility Lead partners closely with:

• IHWA operations
• Stars
• Analytics
• IT
• External vendors

Key responsibilities include:

• Designing and maintaining eligibility criteria
• Minimizing overlap across in‑home programs
• Proactively identifying and resolving eligibility risks
• Translating program and quality requirements into executable eligibility rules, data files, and automated processes

Operating with a high degree of autonomy, the IHWA In‑Home Eligibility Lead analyzes complex data, exercises sound judgment, and drives continuous improvement in eligibility processes to support program growth, vendor performance, and member experience. The role also supports:

• The transition from manual processes to automated, scalable solutions
• Ensuring readiness for future growth and evolving business needs

Qualifications

• Bachelor’s degree in business, healthcare administration, public health, information systems, or a related field; equivalent experience considered
• 5+ years of experience in healthcare operations, program delivery, eligibility management, or performance analytics
• Demonstrated experience managing eligibility criteria and file delivery across multiple vendors or partners
• Strong understanding of in‑home healthcare programs, quality initiatives, or Stars‑related workflows preferred
• Proven ability to work with complex data sets, including eligibility files, member lists, and disposition data
• Experience collaborating cross‑functionally with IT, analytics, operations, and vendor partners
• Strong analytical and problem‑solving skills, with the ability to identify eligibility risks, inconsistencies, or gaps
• Excellent communication skills, including the ability to explain complex eligibility logic to technical and non‑technical stakeholders
• Ability to manage multiple priorities and deadlines in a fast‑paced, high‑visibility environment
• Proficiency with SQL
• Proficiency with data and reporting tools (e.g., Excel, SQL, Power BI, Tableau, or similar)

Requirements

• Experience supporting Quality Focused Visits (QFV) or similar quality‑driven in‑home programs
• Familiarity with Medicare Advantage, Stars measures, and member eligibility requirements
• Experience designing or managing daily eligibility file processes and automation initiatives
• Background in vendor governance, performance monitoring, or contract support
• Experience defining eligibility logic, prioritization rules, and exclusion criteria to minimize overlap and operational risk
• Knowledge of data governance, data quality controls, and audit readiness
• Experience working with APIs or automated data exchanges with external partners
• Master’s degree in healthcare administration, public health, data analytics, or a related field

Remote-Work-At-Home Requirements

• Minimum download speed of 25 Mbps and upload speed of 10 Mbps required; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Employees in California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for their internet expense
• Humana will provide telephone equipment appropriate to meet business requirements
• Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
• Occasional travel to Humana's offices for training or meetings may be required

Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $115,200 - $158,400 per year This job is eligible for a bonus incentive plan based on company and/or individual performance.

Benefits

• 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
• Many other opportunities

Application Deadline 06-12-2026