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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
Timely file delivery across multiple vendor partners
This supports high‑quality execution, Stars outcomes, and operational scalability. The Eligibility Lead partners closely with:
IHWA operations
Stars
Analytics
IT
External vendors
Key responsibilities include:
Designing and maintaining eligibility criteria
Minimizing overlap across in‑home programs
Proactively identifying and resolving eligibility risks
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
Qualifications
Bachelor’s degree in business, healthcare administration, public health, information systems, or a related field; equivalent experience considered
5+ years of experience in healthcare operations, program delivery, eligibility management, or performance analytics
Demonstrated experience managing eligibility criteria and file delivery across multiple vendors or partners
Strong understanding of in‑home healthcare programs, quality initiatives, or Stars‑related workflows preferred
Proven ability to work with complex data sets, including eligibility files, member lists, and disposition data
Experience collaborating cross‑functionally with IT, analytics, operations, and vendor partners
Strong analytical and problem‑solving skills, with the ability to identify eligibility risks, inconsistencies, or gaps
Excellent communication skills, including the ability to explain complex eligibility logic to technical and non‑technical stakeholders
Ability to manage multiple priorities and deadlines in a fast‑paced, high‑visibility environment
Proficiency with SQL
Proficiency with data and reporting tools (e.g., Excel, SQL, Power BI, Tableau, or similar)
Requirements
Experience supporting Quality Focused Visits (QFV) or similar quality‑driven in‑home programs
Familiarity with Medicare Advantage, Stars measures, and member eligibility requirements
Experience designing or managing daily eligibility file processes and automation initiatives
Background in vendor governance, performance monitoring, or contract support
Experience defining eligibility logic, prioritization rules, and exclusion criteria to minimize overlap and operational risk
Knowledge of data governance, data quality controls, and audit readiness
Experience working with APIs or automated data exchanges with external partners
Master’s degree in healthcare administration, public health, data analytics, or a related field
Remote-Work-At-Home Requirements
Minimum download speed of 25 Mbps and upload speed of 10 Mbps required; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Employees in California, Illinois, Montana, or South Dakota will receive a bi-weekly payment for their internet expense
Humana will provide telephone equipment appropriate to meet business requirements
Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
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.
$115,200 - $158,400 per year
This job is eligible for a bonus incentive plan based on company and/or individual performance.
Benefits
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)
