Job Details
Informatics Lead
**Become a part of our caring community and help us put health first**
The Informatics Lead is responsible for leading the development and refinement of EOC volume forecasting models for Humana Clinical Pharmacy Review (HCPR) activities related to pharmacy prior authorization requests. This position is instrumental in supporting operational resource planning and integrating business initiatives while ensuring forecasts accuracy.
The Informatics Lead leverages its advanced knowledge of data, modeling, optimization, and tools. Applies disciplined analytics to predict behavior and optimize programs and products to maximize revenue growth. Utilizes advanced or predictive modeling to develop, test and validate cases that improve the outcomes and quality of the programs we offer. Key responsibilities include:
Lead the design, implementation, and continuous improvement of forecasting models to project pharmacy prior authorization review volumes.
+ Analyze historical and current data to identify key drivers and trends affecting HCPR workload.
+ Integrate impacts from business initiatives, regulatory changes, and operational adjustments into forecasting, including:
+ Modifications in product offerings or pharmacy benefit design.
+ Shifts in member demographics and population mix.
+ Updates to clinical criteria, policies, or prior authorization procedures.
+ Deployment of new programs, technology solutions, or workflow automation.
+ Compliance with regulatory requirements and benefit mandates.
+ Collaborate with operational, clinical, and business partners to gather relevant inputs and communicate forecast outcomes and implications.
+ Prepare and deliver clear, comprehensive reports and presentations on forecasting methodology, results, and variances for leadership and stakeholders.
+ Document assumptions and methodologies in accordance with organizational policies
+ Uphold data integrity, transparency, and confidentiality consistent with applicable regulations and company policies.
**Use your skills to make an impact**
**Required Qualifications**
+ Utilization Management Experience
+ Proficiency in using technologies such as SQL and SAS
+ Strategic thinking and planning capabilities
+ Organized and detail-oriented
+ Experience in defining and executing measurement programs
+ Experience with advanced analytics, including program evaluation and optimization
+ Excellent verbal and written communication
+ Able to articulate and present findings and insights to senior leadership
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
**Preferred Qualifications**
+ Master's degree and 4 or more years of technical experience
+ Pharmacy claim knowledge
+ Six Sigma certification
+ Advanced experience in SAS, SQL, Databricks, Python, QlikView, Power BI, Hadoop or similar tools
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.
$117,600 - $161,700 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: 11-06-2025
**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.
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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 https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
The Informatics Lead is responsible for leading the development and refinement of EOC volume forecasting models for Humana Clinical Pharmacy Review (HCPR) activities related to pharmacy prior authorization requests. This position is instrumental in supporting operational resource planning and integrating business initiatives while ensuring forecasts accuracy.
The Informatics Lead leverages its advanced knowledge of data, modeling, optimization, and tools. Applies disciplined analytics to predict behavior and optimize programs and products to maximize revenue growth. Utilizes advanced or predictive modeling to develop, test and validate cases that improve the outcomes and quality of the programs we offer. Key responsibilities include:
Lead the design, implementation, and continuous improvement of forecasting models to project pharmacy prior authorization review volumes.
+ Analyze historical and current data to identify key drivers and trends affecting HCPR workload.
+ Integrate impacts from business initiatives, regulatory changes, and operational adjustments into forecasting, including:
+ Modifications in product offerings or pharmacy benefit design.
+ Shifts in member demographics and population mix.
+ Updates to clinical criteria, policies, or prior authorization procedures.
+ Deployment of new programs, technology solutions, or workflow automation.
+ Compliance with regulatory requirements and benefit mandates.
+ Collaborate with operational, clinical, and business partners to gather relevant inputs and communicate forecast outcomes and implications.
+ Prepare and deliver clear, comprehensive reports and presentations on forecasting methodology, results, and variances for leadership and stakeholders.
+ Document assumptions and methodologies in accordance with organizational policies
+ Uphold data integrity, transparency, and confidentiality consistent with applicable regulations and company policies.
**Use your skills to make an impact**
**Required Qualifications**
+ Utilization Management Experience
+ Proficiency in using technologies such as SQL and SAS
+ Strategic thinking and planning capabilities
+ Organized and detail-oriented
+ Experience in defining and executing measurement programs
+ Experience with advanced analytics, including program evaluation and optimization
+ Excellent verbal and written communication
+ Able to articulate and present findings and insights to senior leadership
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
**Preferred Qualifications**
+ Master's degree and 4 or more years of technical experience
+ Pharmacy claim knowledge
+ Six Sigma certification
+ Advanced experience in SAS, SQL, Databricks, Python, QlikView, Power BI, Hadoop or similar tools
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.
$117,600 - $161,700 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: 11-06-2025
**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.
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 https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Job #NLX283414201