Process Improvement Professional – National Clinical Ops, Medicaid

🔥 0 minutes ago

🐊 Florida, Illinois, +6 more states – Remote

🐊 Florida – Remote 🌽 Illinois – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌴 South Carolina – Remote ⚔️ Virginia – Remote

💵 $65k - $88.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🏥 Clinical Operations

🦅 H1B Visa Sponsor

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Partner closely with Clinical Operations, subject matter experts, and clinical teams to support Medicaid Medical Directors • Ensure clinical operational processes are standardized, effective, and aligned with governing and NCQA requirements • Analyze and measure the effectiveness of existing business processes • Develop sustainable, repeatable, and quantifiable process improvements • Initiate, develop, and recommend best business practices and procedures for physical health clinical and nonclinical teams • Standardize and maintain Medicaid Medical Director operating procedures, workflows, and templates • Manage controlled document updates, including intake, versioning, approvals, and publication • Coordinate Medicaid Medical Director training, attestation, and adoption • Establish consistent procedures to reduce variation across markets • Interpret organizational policies and procedures to determine appropriate actions and ensure compliance • Execute process improvement, development, and evaluation strategies • Analyze results and recommend improvements • Collaborate cross-functionally on process development and implementation support • Travel occasionally to Humana offices for training or meetings

🎯 Requirements

• Bachelor's degree or 3+ years relevant experience in lieu of degree • 3+ years of experience efficiently navigating multiple databases, systems, and screens simultaneously • Proficiency with Zoom and Microsoft Teams • Proficiency with Microsoft Office tools including Outlook, LUCID, Word, Excel, and PowerPoint • Prior experience in a fast-paced insurance or healthcare setting • Experience creating and maintaining compliant, user-friendly SharePoint sites • Ability to interpret complex information and assess operational needs • Preferred: Previous Medicare/Medicaid or Health Plan experience in Utilization Management • Preferred: Power BI experience • Minimum download speed of 25 Mbps and upload speed of 10 Mbps for home internet • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information

🏖️ Benefits

• Bonus incentive plan based upon company and/or individual performance • Medical, dental and vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental and caregiver leave • Short-term disability • Long-term disability • Life insurance • Whole-person wellness support • Remote work arrangement • Dedicated home workspace and internet requirements to support effective remote work