Senior Process Improvement Professional

🔥 7 minutes ago

🏈 Ohio, Michigan – Remote

🏈 Ohio – Remote 🚗 Michigan – Remote

💵 $78.4k - $107.8k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

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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

• Lead process improvement initiatives supporting the Michigan Long-Term Services and Supports (LTSS) program, including HCBS, care management, utilization management, quality, reporting, and operational workflows • Analyze LTSS operational workflows and identify opportunities to improve efficiency, quality, compliance, and member outcomes • Partner with Care Management, Utilization Management, Quality, Reporting, Provider, and Compliance teams on process redesign and implementation • Develop standardized LTSS workflows, policies, procedures, audit tools, and process documentation • Monitor Michigan contract requirements and support operational changes needed to maintain LTSS compliance • Conduct root cause analysis of operational issues, performance gaps, audit findings, grievances, appeals, and quality concerns • Use data and reporting to identify trends, develop recommendations, and measure process improvement effectiveness • Facilitate training, process mapping, workflow redesign, and change management initiatives across LTSS functions • Support state-directed initiatives, regulatory changes, EVV-related processes, assessment requirements, and LTSS program enhancements • Develop key performance indicators and monitoring tools to evaluate process outcomes and operational effectiveness • Research industry best practices and emerging trends related to Medicaid, HCBS, LTSS, care coordination, and quality improvement • Prepare LTSS presentations, reports, and executive summaries for leadership and stakeholders • Serve as a subject matter resource for continuous improvement methodologies and operational excellence initiatives • Travel up to 10%, including periodic visits to Humana's Detroit, Michigan office and occasional travel to Humana offices for training or meetings

🎯 Requirements

• Must reside in Michigan or within a 40-mile radius of the Michigan border in Ohio or Indiana • Bachelor's degree • Three (3) or more years of experience in process improvement, healthcare operations, quality improvement, project management, or a related field • Experience working with healthcare, managed care, Medicaid, LTSS, HCBS, or population health programs • Experience interpreting operational and performance data to drive business decisions • Expertise in analyzing business processes, identifying root causes, and implementing process improvements • Advanced proficiency with Microsoft Office applications, including Excel and PowerPoint • Excellent verbal and written communication skills • Experience presenting process improvement opportunities, project updates, and performance metrics to leadership teams • Monday through Friday availability, 8:00 AM to 5:00 PM Eastern Time • Master's degree in healthcare administration, business administration, public health, or related field preferred • Lean, Six Sigma, PMP, or other process improvement certification preferred • Experience with Michigan Medicaid and LTSS programs preferred • Knowledge of Michigan HCBS waiver requirements and regulatory standards preferred • Experience supporting state contract compliance, audits, or quality improvement initiatives preferred

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical, dental, and 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 • Remote work arrangement • Dedicated home workspace and internet requirements to support work from home