Senior Process Improvement Professional

🕒 4 dias atrás

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $78.400 - $107.800 / ano

⏰ Tempo Integral

🟠 Sênior

⚙️ Operações

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Humana

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1961

🏥 Saúde

🛡️ Seguros

⚕️ Seguro de Saúde

Healthcare • Insurance • Healthcare Insurance

A Humana é uma empresa de saúde dedicada a gerar um impacto positivo na saúde de indivíduos, comunidades e do sistema de saúde como um todo. Com foco em colocar a saúde em primeiro lugar, a Humana atende a uma ampla e diversa gama de populações, incluindo idosos e militares, oferecendo planos Medicare Advantage (HMO, PPO e PFFS). A Humana está comprometida em promover uma cultura de pertencimento e respeito mútuo, oferecendo benefícios competitivos e flexíveis para garantir a segurança financeira de seus funcionários e de suas famílias. A empresa se orgulha de criar um ambiente de trabalho inclusivo, no qual todos têm a oportunidade de ter sucesso.

Descrição

• Analyze and measure the effectiveness of existing business processes • Develop sustainable, repeatable, and quantifiable business process improvements • Provide business ownership and leadership for strategic Medicaid enrollment and waiver modernization initiatives • Lead enterprise member movement enhancements • Define requirements, conduct testing, validate results, and support implementation with IT and business stakeholders • Identify operational risks and develop solutions minimizing impacts to clinical, claims, finance, and enrollment operations • Monitor post-implementation performance and business outcomes • Provide operational ownership and oversight for multiple Medicaid waiver enhancements • Govern LTSS waiver-related processes, updates, validations, and issue resolution • Manage the LTSS mailbox and coordinate review, validation, and processing of waiver-related member information • Develop scalable processes that reduce manual intervention and improve waiver data accuracy • Liaise across business operations, technology, finance, claims, clinical, and enrollment teams • Facilitate stakeholder alignment on priorities, requirements, testing, implementation, and operational readiness • Communicate project progress, risks, dependencies, and recommendations to leadership • Support training, change management, and adoption efforts • Identify automation opportunities and establish monitoring, reporting, and governance practices • Support enterprise Medicaid operations and enrollment modernization initiatives

🎯 Requisitos

• Experience leading complex healthcare, Medicaid, process improvement, operational, or technology initiatives • Demonstrated success managing cross-functional projects involving multiple business areas • Strong analytical, problem-solving, and risk management capabilities • Experience developing business requirements, testing strategies, operational processes, and implementation plans • Medicaid managed care, enrollment, eligibility, waiver, or member administration experience preferred • Experience with Medicare and/or Medicaid preferred • Experience with Medicare Reconciliation preferred • Experience analyzing, interpreting, and displaying financial, health, competitive, and performance measurement data preferred • Experience leading strategy and/or operational planning preferred • Experience consulting to, and/or influencing, executive leadership preferred • Experience influencing change in a matrix organization preferred • Experience with Microsoft Excel chart creation, macros, and pivot tables preferred • Experience with Power BI preferred • Minimum home internet speed of 25 Mbps download and 10 Mbps upload for home or hybrid home/office employees • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefícios

• Bonus incentive plan based upon company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Personal wellness support and smart healthcare decision resources

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