LTSS Process Improvement Professional

Humana; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

Humana is seeking a Process Improvement Professional II to support Medicaid implementation activities. The role focuses on translating high-level goals into usable documentation and tools that enable scalable, repeatable deployment across states.

You will draft policies, workflows, and readiness materials, review member/provider documents, and ensure alignment with contracts and regulatory requirements. This remote US role collaborates across the organization to maintain quality and compliance.

Qualifications

• Bachelor's degree or 3 years' equivalent experience in health plan operations.
• 2+ years' experience supporting LTSS Provider, LTSS Care Management (CM), or LTSS Utilization Management (UM) roles.

Responsibilities

• Assist in drafting and reviewing policies, procedures, program descriptions, workflows, and readiness materials.
• Review member and provider manuals for consistency and regulatory alignment.
• Coordinate internal review/approval for documents and ensure proper version control.
• Document process steps and build initial workflows for review by seniors.
• Support development of clinical auditing tools and operational documents across markets.

Education

Bachelor's degree or 3 years' equivalent experience in health plan operations

Job description

Become a part of our caring community

The Process Improvement Professional supports the development and execution of Medicaid implementation activities by partnering closely with Process Improvement Leads and Senior Professionals. This role helps bring strategy to life by translating high-level business goals and regulatory requirements into operational documentation and tools that support a scalable, repeatable implementation model.

The Process Improvement Professional plays a key role in drafting and reviewing policies and procedures, program descriptions, workflows, training content, and other readiness materials required for new state launches. They support business reviews of member and provider-facing documents, assist with document submissions through internal approval processes, and help ensure alignment with contract requirements and the overall strategic vision.

This professional contributes to initiatives that solve complex business challenges through research, collaboration, and thoughtful documentation. While work assignments are varied and may require independent interpretation and action, the role works under the guidance of senior team members and collaborates cross-functionally to ensure consistency and accuracy in deliverables. They are essential to ensuring quality, compliance, and operational readiness across all new Medicaid markets.

A successful Process Improvement Professional II is detail-oriented, organized, and passionate about enhancing the member and provider experience. They will support strategic planning through documentation, workflow development, and process alignment, ensuring that all deliverables reflect Humana's commitment to excellence, compliance, and person-centered care.

Position Responsibilities

• Support the development and maintenance of implementation documents such as policies and procedures, program descriptions, letters, and assessments by drafting, editing, formatting, and conducting preliminary reviews before submission to Senior Professionals or Leads.
• Assist in reviewing member and provider manuals, flagging inconsistencies or compliance gaps, and supporting alignment with state requirements.
• Prepare and submit internal documentation through established review and approval processes, ensuring proper version control, file management, and coordination with SMEs and reviewers.
• Collaborate with the Senior Process Improvement Professional to review training materials and job aids, offering feedback based on document content and providing clarifying information to the training team as needed.
• Participate in workflow development activities by documenting process steps, creating visual workflows, and helping build initial drafts to be reviewed and finalized by the Senior Professional or Lead.
• Support the creation and maintenance of clinical auditing tools and other operational tools that will be used across markets, ensuring consistency and accessibility.
• Assist in the setup and documentation of shared mailboxes, fax numbers, and other communication tools for new state implementations.
• Research and gather information from contracts, regulatory documents, and internal stakeholders to support the development of implementation materials.
• Track progress on document creation and submission tasks using internal project tracking systems (e.g., Smartsheet, OneNote, SharePoint), ensuring deadlines and deliverables are met.
• Participate in meetings and working sessions with Senior Professionals and Leads to take notes, summarize discussions, and follow up on assigned tasks.
• Provide general project support to the cohort team and contribute to broader team efforts aimed at process improvement and operational readiness.
• Assist in interpreting contract requirements and converting them into clear and understandable summaries or draft documentation for review by senior team members.
• Perform quality checks on documentation to ensure clarity, formatting, and alignment with submission standards.
• Take on stretch assignments or special projects to support business readiness and further develop expertise in Medicaid implementation and process improvement.

Required Qualifications

• Bachelor's degree or 3 years' equivalent experience working in health plan operations.
• 2 plus years' experience supporting LTSS Provider, LTSS Care Management (CM), or LTSS Utilization Management (UM) roles.

Preferred Qualifications

• Project management experience.
• Medicare/Medicaid integrated model experience.
• Experience/knowledge working in a cross-functional settings.

Additional Information

Location: Remote US

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

Work at Home Requirements

To ensure Home or Hybrid Home/Office employ