Remote Utilization Management Jobs in Washington

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Humana is seeking a hands-on technology leader to drive enterprise integrations, interoperability, and clinical data platform initiatives across payer and provider ecosystems.
As the Director, Technology Solutions - Integrations and Clinical Data Platform, you will lead modernization efforts leveraging cloud, data analytics, AI, and automation to improve operational efficiency, scalability, and healthcare outcomes.

Key Responsibilities

• Lead enterprise integrations across APIs, HL7, FHIR, EDI/X12, and Epic ecosystems.

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

• Provide technical leadership for Epic Tapestry and preferably Compass Rose integrations.

• Support healthcare operations including Utilization Management (UM), Care Management (CM), HEDIS, STAR Ratings, and Value-Based Care initiatives.

• Leverage AI, automation, and analytics to streamline workflows and improve operational performance.

• Partner with business, clinical, and technology leaders to define scalable, AI-first solutions.

• Lead engineering teams, architecture decisions, and vendor engagements.

Use your skills to make an impact

Required Qualifications

• 15+ years of healthcare technology leadership experience.

• Deep experience with Epic Tapestry; Compass Rose preferred.

• Strong hands-on expertise with Databricks, Snowflake, APIs, HL7, FHIR, and healthcare interoperability.

• Experience supporting payer and clinical workflows including UM, CM, HEDIS, and STAR programs.

• Proven experience leveraging analytics, automation, and AI within healthcare operations.

• Strong leadership, communication, and execution skills.

Preferred Qualifications

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

• Cloud platform experience (Azure, AWS, or GCP).

• Experience leading large-scale healthcare transformation initiatives.

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

Why Humana?

At Humana, we know your well-being is important to you, and it's important to us too. That's why we're committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life.Just to name a few:

• Work-Life Balance

• Generous PTO package

• Health benefits effective day 1

• Annual Incentive Plan

• 401K -Excellent company match

• Well-being program

• Paid Volunteer Time Off

If you share our passion for helping people, we likely have the right place for you at Humana.

Work at Home Guidance

To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• 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

SSN Alert Statement

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

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, 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 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.