Director, CMS & Provider Direct Channel

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The Director, CMS & Provider Direct Channel (Director, Product Management) leads Humana’s connectivity strategy across CMS-mandated and direct interoperability channels. This leader is accountable for execution across CMS compliance APIs, voluntary exchange pathways, and direct-to-provider connectivity efforts. The role focuses on translating regulatory requirements and market opportunities into scalable capabilities, stronger provider adoption, and measurable business value. You will report to AVP, Interoperability.

Primary Responsibilities

• Lead strategy and execution for the CMS & Provider Direct Channel, including CMS compliance APIs, voluntary interoperability capabilities, and direct-to-provider connectivity.
• Own channel performance across regulatory delivery, provider adoption, and ongoing channel expansion.
• Translate CMS requirements, policy direction, and enterprise priorities into practical channel strategies and executable roadmaps.
• Partner across product, technology, operations, compliance, legal, and business teams to deliver compliant, scalable, and provider-ready capabilities.
• Drive adoption of CMS and direct connectivity solutions by aligning channel capabilities to provider needs and business priorities.
• Oversee execution for provider-facing APIs and direct exchange capabilities that improve access, reduce friction, and enable interoperability at scale.
• Define and manage KPIs for channel readiness, compliance execution, adoption, utilization, and performance.
• Support external engagement tied to CMS mandates, voluntary commitments, and direct provider connectivity opportunities.
• Identify risks, dependencies, and execution barriers early, and drive cross-functional resolution.
• Lead and develop a strong team across channel delivery, partner coordination, and execution management.
• Continuously monitor regulatory change, market movement, and provider demand to strengthen channel performance over time.

Outcomes

• Strong execution against CMS interoperability requirements and timelines.
• Reliable, scalable CMS compliance API capabilities.
• Greater provider adoption of direct and voluntary connectivity solutions.
• Simpler provider access to Humana data through compliant and practical exchange pathways.
• Stronger alignment between regulatory commitments and enterprise priorities.
• Clear channel performance through defined metrics, active management, and continuous improvement.

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s degree in business, healthcare administration, or a related field
• 6+ years of progressive leadership experience in interoperability, digital health, healthcare technology, product management, regulatory delivery, or related functions, ideally in healthcare
• Experience leading delivery of API-based capabilities, regulatory programs, or provider-facing interoperability solutions.
• Strong understanding of CMS interoperability requirements, healthcare data exchange, provider workflows, and operational execution
• Proven ability to lead across business, compliance, operational, and technology teams
• Demonstrated ability to analyze complex issues, communicate effectively and drive solutions
• Track record of driving execution in complex, cross-functional environments

Preferred Qualifications

• Master’s degree in business, healthcare administration, or related field
• Experience working with national interoperability frameworks
• Experience leading provider connectivity, network growth, or interoperability strategy
• Familiarity with payer-provider operational workflows
• Demonstrated experience working directly with CMS and other government entities

Additional Information

Location: Remote Nationwide (Louisville, KY preferred)

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

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.

 

$168,000 - $231,000 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: 05-15-2026

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 at Humana.com and at CenterWell.com.

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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.