Process Improvement Lead, Medicaid

Humana Inc; Columbia (SC); Remote; USD 95,000 - 131,000; Full time

Benefits offered by this job

Health benefits

401(k)

Paid time off

Parental leave

Job summary

Humana, Inc. is seeking a Process Improvement Lead for the MedicaidApply team in Columbia, SC, with a remote work option. You will analyze and measure current processes, identify inefficiencies, and drive reusable, measurable improvements across the organization.

Reporting to the Director of Health Services, you will lead 1–2 direct reports, coordinate cross‑functional initiatives, and ensure alignment with NCQA standards while reducing cost and risk.

Qualifications

• Bachelor's degree required.
• 5+ years of process improvement experience.
• 2+ years of project leadership experience.
• 2+ years of case management or utilization management experience.
• RN or MSW license preferred in state of employment.

Responsibilities

• Analyze and measure the effectiveness of existing processes and develop improvements.
• Lead and execute operational excellence initiatives and drive best practices.
• Review processes for compliance, audits, quality reviews (e.g., NCQA).
• Design and implement new processes and training to improve safety and productivity.

Skills

Process improvement

Project leadership

Case management

Utilization management

Education

Bachelor's degree

Tools

Lean Six Sigma

Job description

## Process Improvement Lead, MedicaidApply: Columbia, SC: Work at Home - South Carolina: Full time: Posted Yesterday: R-430479# **Become a part of our caring community**The Process Improvement Lead analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Lead works on problems of diverse scope and complexity ranging from moderate to substantial. You will report to the Director of Health Services and have 1-2 direct reports. The Process Improvement Lead is responsible for developing and executing operational excellence initiatives within the organization. This role uses structured methodologies to identify inefficiencies, recommend solutions, and drive implementation of best practices across business processes.The Process Improvement Lead will research best business practices within and outside the organization to establish benchmarks for the team. You will review processes and procedures, work to streamline the department, ensuring better collaboration, efficiency and compliance. You will design and build out new processes and practices for the team. Act as the point person for the department regarding resources, policies and procedures such as compliance, audits, quality reviews like NCQA materials. In this role, you will also collect and analyze data, identifying gaps and building out process and procedures to develop best practices while minimizing risk. You will review job aids, new hire onboarding and training process to ensure the team is following best in class business practices and procedures that focus on enhanced safety, increased productivity and reduced cost. You may advise leadership to develop functional strategies (often segment specific) on matters of significance. # **Use your skills to make an impact****Required Qualifications** * Bachelor's degree* 5 or more years of process improvement experience* 2 or more years of project leadership experience* Must have 2 or more years of experience in case management and/or utilization management experience **Preferred Qualifications** * Active Registered Nurse (RN) or Master of Social Work (MSW) license in the state of employment* Experience with Medicaid compliance preferred* At least 2 years of Medicaid experience* Certification in Lean, Six Sigma, or a comparable process improvement methodology preferred* Ability to lead multiple initiatives and drive change within a matrixed organization* Familiarity with project management tools and resources**Scheduled Weekly Hours**40**Pay Range**The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$94,900 - $130,500 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.**Description of Benefits**Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.