• Job Description

  Req#: R-405025

  Become a part of our caring community and help us put health first
  

  The Vendor Management Lead oversees vendor management operations from a market perspective, ensuring alignment with Humana’s clinical and operational standards. This role directs a team of RN professionals, fosters effective vendor and provider relationships, and drives resolution of clinical and operational issues to support quality care and compliance.

  The Vendor Management Lead (RN) is responsible for overseeing the vendor management functions from a market perspective, ensuring alignment between Humana’s business and clinical operations, vendor partners, and providers. This role provides strategic direction, leadership, and support to a team of Senior Vendor Management Professionals (RN), facilitating effective issue resolution, gap identification, and process optimization to advance quality care and operational excellence. This leader will build positive strategic partnerships with Contracting to align on Institutional Special Needs Plan providers and have oversight of SNF provider network and optimization from the clinical perspective. This role will also work with Provider Engagement to monitor outcomes for Value Based and Delegated Services Providers.

  Key Responsibilities

  • Provide strategic leadership and guidance to the Senior Vendor Management Professional (RN) team, ensuring effective execution of vendor management initiatives in accordance with Humana’s policies and regulatory requirements.
  • Oversee and optimize vendor relationships, including performance monitoring, compliance management, and the resolution of complex operational and clinical issues.
  • Facilitate collaboration between Humana, vendor partners, and providers, ensuring clear communication channels and the successful implementation of market-based strategies.
  • Support the review of clinical authorizations and ensure consistency with established guidelines for various levels of care, leveraging clinical expertise and best practices.
  • Identify systemic gaps and process improvement opportunities across vendor partnerships, developing and implementing action plans to close gaps and enhance service delivery.
  • Analyze market trends, operational data, and vendor performance metrics to inform decision-making and drive continuous quality improvement.
  • Ensure adherence to privacy, security, and enterprise information protection protocols, escalating issues as appropriate and maintaining compliance with internal procedures.
  • Mentor and develop team members, fostering a culture of accountability, collaboration, and professional growth.
  • Participate in strategic planning, vendor selection, and contract negotiations as needed, ensuring alignment with organizational objectives and clinical standards.
  • Represent the vendor management function in cross-functional meetings, audits, and enterprise initiatives.

  
  Use your skills to make an impact
  

  Required Qualifications

  • Active and unrestricted Compact license (RN) license required

  • Prior experience in a healthcare or insurance setting

  • 5 + years of Utilization Management experience

  • 3 + years of vendor management and/or process or project management experience

  • Demonstrated ability to define and track KPIs and/or service level agreement metrics and other measurable success criteria

  • Proven verbal and written communication skills with the ability to interact effectively across all organizational levels

  • Ability to break down complex problems into actionable steps

  • Demonstrated critical thinking and analytical problem-solving skills

  • Exceptional relationship management skills

  • Demonstrates accuracy and thoroughness, identifies process improvements

  • Proficient in Microsoft Office applications including Word, Excel and PowerPoint

  • Advanced facilitation skills with experience leading cross-functional discussions

  Preferred Qualifications

  • Master's Degree

  • Knowledge of claims processes

  • Knowledge of Stars and HEDIS

  • Knowledge of clinical quality benchmarks and reporting requirements for value base providers

  • Certification with Six Sigma and/or the Project Management Institute

  • Knowledge of Medicare Advantage

  • Grievance and Appeals experience

  Additional Information

  This position will require 5-15% travel within the market.

  Work-At-Home Requirements:

  • WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

  • A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

  • Satellite and Wireless Internet service is NOT allowed for this role.

  • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

  Interview Format:

  As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.
  
  If you are selected, you will receive correspondence inviting you to participate in a HireVue assessment. You will have a set of questions and you will provide responses to each question. You should anticipate this to take about 15 - 20 minutes. Your answers will be reviewed, and you will subsequently be informed if you will be moving forward to next round.

  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.

  
  

  $94,900 - $130,500 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: 02-20-2026

  
  About us
  

  Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

  
  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.

• About the company

  Humana looks at every facet of your life and works with you to create a path to health that fits your unique needs

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