Process Improvement Lead, Medicaid

Humana Inc; United States; On-site; USD 95,000 - 131,000; Full time

Job summary

Humana Inc. is seeking a Process Improvement Lead to analyze and improve healthcare business processes, developing scalable, data-driven improvements.

You will lead a small team and partner with QA, compliance, and health services to implement best practices that increase efficiency and reduce risk. You will oversee process design, onboarding of new procedures, and measurement against benchmarks such as NCQA materials, with a focus on safety, productivity, and cost reduction across the

Qualifications

• Bachelor's degree
• 5+ years of process improvement experience
• 2+ years of project leadership experience
• 2+ years of case management and/or utilization management experience

Responsibilities

• Analyze and measure the effectiveness of existing business processes.
• Develop sustainable, repeatable and quantifiable improvements across processes.
• Lead initiatives and drive implementation of best practices within Health Services.

Skills

Process improvement

Project leadership

Case management

Utilization management

Education

Bachelor's degree

RN license (state of employment)

Job description

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

$94,900 - $130,500 per year

This 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.

About Us

Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.