Director, CMS & Provider Direct Channel

Humana • Louisville, KY

3d • Remote

About The Position

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.

Requirements

• 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

Nice To Haves

• 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

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.

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)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Director