Director Utilization Management Jobs in Kentucky

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Healthcare is entering the most consequential technology shift of the next decade - and Humana is at the center of it. We're seeking a Director of Engineering to lead the AI-first transformation of our clinical technology organization, embedding AI-assisted engineering, agentic workflows, and modern data platforms directly into how we build, test, and deliver enterprise healthcare systems.
This isn't an incremental modernization role. You'll be building the engineering org of the next decade - one where AI tools like Claude are core infrastructure, not an experiment - while driving mission-critical delivery across our Epic Tapestry (Utilization Management) and Compass Rose (Care Management) platforms. If you want to look back in ten years and point to the moment healthcare engineering fundamentally changed, this is that moment.

Why This Role

• Massive scope, real stakes. You'll help lead the technology backbone for one of the nation's largest Medicare Advantage payers, supporting millions of members through mission-critical UM and CM platforms - with a hard December 2026 UM go-live and April 2027 CM go-live.

• AI-first, not AI-adjacent. You will own the mandate to make AI-assisted engineering (Claude Code and agentic development workflows) the default way our teams build software - not a pilot program bolted onto legacy process.

• A decade-defining opportunity. Healthcare AI is moving from administrative automation to core clinical and operational infrastructure. You'll be one of the leaders who defines what "AI-native" engineering looks like inside a Fortune 50 payer.

• Direct executive visibility. This role partners closely with senior technology and clinical leadership and has a direct line of sight to enterprise-level compliance and transformation initiatives (including CMS-0057 interoperability mandates).

Key Responsibilities

• Lead and scale an engineering organization responsible for enterprise integrations, clinical data platforms, and payer/provider interoperability (APIs, HL7, FHIR, EDI/X12, Epic ecosystem).

• Own the AI-first engineering agenda: drive adoption of AI-assisted development (e.g., Claude Code), agentic workflows, and automation across the SDLC - from requirements to testing to production support.

• Provide technical and delivery leadership across Epic Tapestry (UM) and Compass Rose (CM) integration programs, partnering with a multi-vendor ecosystem (Deloitte, Wipro, Rackspace, Sagility) to hold delivery accountable.

• Drive architecture and delivery for clinical and healthcare data platforms using Databricks and Snowflake.

• Champion measurable "Return on AI Investment" (ROAI) - identifying and scaling use cases where AI materially compresses delivery timelines, testing cycles, and operational cost.

• Partner with clinical, product, and compliance leaders to translate healthcare operations - Utilization Management, Care Management, HEDIS, STAR Ratings, and Value-Based Care - into scalable, AI-enabled technical solutions.

• Build, mentor, and grow a high-performing engineering team, instilling an AI-first mindset and modern engineering culture as a durable capability, not a one-time initiative.

• Represent engineering in executive and board-level conversations on technology transformation, delivery risk, and AI strategy.

What Success Looks Like

Within your first year, you will have measurably shifted how our engineering org builds software - AI-assisted development as the default, not the exception - while delivering against critical Epic UM and CM milestones. You'll have built a team that others across the enterprise look to as the model for what AI-native healthcare engineering looks like.

Use your skills to make an impact

Required Qualifications

• 10+ years of engineering leadership experience

• Demonstrated experience leading AI-first or AI-assisted engineering transformation - adoption of tools like Claude Code, Copilot, or comparable agentic/AI development platforms at team or org scale.

• Strong technical foundation in enterprise integration and interoperability: APIs, HL7, FHIR, EDI/X12.

• Experience with modern cloud data platforms (Databricks, Snowflake, or equivalent).

• Track record of leading engineering teams through large-scale platform transformation, including multi-vendor delivery environments.

• Executive-level communication skills - able to translate technical delivery into business and clinical outcomes for senior leadership.

Preferred Qualifications

• Proven experience supporting payer or clinical operations - UM, CM, HEDIS, STAR Ratings, or Value-Based Care.

• Experience in healthcare technology (payer, provider, or health tech environments).

• Direct experience with Epic Tapestry and/or Compass Rose.

• Experience with Medicare Advantage, commercial payer, or Value-Based Care environments.

• Cloud platform certification or deep hands-on experience (Azure, AWS, or GCP).

• Experience standing up or scaling an AI Center of Excellence, AI governance framework, or enterprise AI adoption program.

• Background leading teams through regulatory-driven transformation (e.g., CMS interoperability mandates).

Additional Information

Work Style: This position's work style is remote from any of the locations listed below. You must reside in close proximity to one of these locations.

Market Location Options:

• Louisville, KY

• Dallas/Frisco, TX

• Washington, DC (Arlington, VA)

• Chicago, IL

• Fort Lauderdale, FL

• Tampa, FL

• New York, NY

• Boston, MA

• Atlanta, GA

• Nashville, TN

• Charlotte, NC

Reporting Structure: You will report to an Associate VP, Technology Solutions

Work at Home Requirements: 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. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. 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.

$172,200 - $236,900 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, 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 atHumana.comand atCenterWell.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.