Process Improvement Pro - Quality & Compliance (Remote)

Visa Hunt; United States; On-site; USD 65,000 - 89,000; Full time

Benefits offered by this job

Remote work

Occasional travel to Humana offices

Job summary

Humana Illinois Market is seeking a Process Improvement Professional who analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable, and quantifiable improvements. This role supports oversight of Critical Incidents and aligns with state audits.

You will collaborate with Care Coordinators, lead data-driven improvements, and deliver monthly and annual reports while training staff on updates to CI procedures.

Qualifications

• Bachelor's degree in a relevant field.
• 2 years of experience in process improvement, compliance measures, auditing, or Medicaid/Medicare care coordination.
• Experience in Care Coaching and/or Care Coordination.
• Strong oral and written communication and presentation skills.
• Excellent analytical skills with data interpretation ability.

Responsibilities

• Collaborate with Care Coordinators to determine strategies to mitigate risk.
• Monitor Care Coordination activity and documentation regarding the Critical Incident.
• Collaborate with Leadership staff regarding closure of Critical Incidents.
• Provide oversight for quarterly State audits of Critical incidents.
• Provide reporting to the Illinois Quality Improvement Committee on Critical Incidents and support Annual Quality report.
• Prepare monthly reports to the State regarding Critical Incidents.
• Provide training for new hires and current staff on CI updates.
• Perform audits focused on improving compliance and quality.
• Review new Critical Incident entries for appropriate classification.
• Develop and review internal quality metrics.
• Support process improvement initiatives and review Job Aids for Learning Design staff.
• Review current Job Aids and Policies and Procedures as requested.
• Create and present education as requested by the Process Improvement Manager.
• Participate in root cause analysis research for audits.
• Make decisions regarding own work methods with minimal direction.

Skills

Process improvement

Auditing

Data analysis

Care coordination

Communication skills

Education

Bachelor's degree

Job description

Humana Illinois Market is seeking a Process Improvement Professional who analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable, and quantifiable improvements. This role supports oversight of Critical Incidents and aligns with state audits.

You will collaborate with Care Coordinators, lead data-driven improvements, and deliver monthly and annual reports while training staff on updates to CI procedures.