In Home Eligibility Lead

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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, and timely file delivery across multiple vendor partners, supporting high‑quality execution, Stars outcomes, and operational scalability.

The Eligibility Lead partners closely with IHWA operations, Stars, analytics, IT, and external vendors to design and maintain eligibility criteria, minimize overlap across in‑home programs, and proactively identify and resolve eligibility risks. This role plays a critical part in 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.

Use your skills to make an impact

Required 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)

Preferred Qualifications

• 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

To ensure Work-at-Home 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.

• Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$115,200 - $158,400 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “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: 06-12-2026

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.

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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