In Home Eligibility Lead

Become a part of our caring community 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 QualificationsBachelor’s degree in business, healthcare administration, public health, information systems, or a related field; equivalent experience considered5+ years of experience in healthcare operations, program delivery, eligibility management, or performance analyticsDemonstrated experience managing eligibility criteria and file delivery across multiple vendors or partnersStrong understanding of in‑home healthcare programs, quality initiatives, or Stars‑related workflows preferredProven ability to work with complex data sets, including eligibility files, member lists, and disposition dataExperience collaborating cross‑functionally with IT, analytics, operations, and vendor partnersStrong analytical and problem‑solving skills, with the ability to identify eligibility risks, inconsistencies, or gapsExcellent communication skills, including the ability to explain complex eligibility logic to technical and non‑technical stakeholdersAbility to manage multiple priorities and deadlines in a fast‑paced, high‑visibility environmentProficiency with SQLProficiency with data and reporting tools (e.g., Excel, SQL, Power BI, Tableau, or similar)Preferred QualificationsExperience supporting Quality Focused Visits (QFV) or similar quality‑driven in‑home programsFamiliarity with Medicare Advantage, Stars measures, and member eligibility requirementsExperience designing or managing daily eligibility file processes and automation initiativesBackground in vendor governance, performance monitoring, or contract supportExperience defining eligibility logic, prioritization rules, and exclusion criteria to minimize overlap and operational riskKnowledge of data governance, data quality controls, and audit readinessExperience working with APIs or automated data exchanges with external partnersMaster’s degree in healthcare administration, public health, data analytics, or a related fieldRemote-Work-At-Home RequirementsTo 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 Hours40Pay RangeThe 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 BenefitsHumana, 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: 06-12-2026About 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,