Process Improvement Specialist

Humana Inc; Kentucky; Remote; USD 65,000 - 89,000; Full time

Job summary

Humana Inc. is looking for a Strategy and Growth Professional II to help drive care and service coordination strategies for Medicaid. This position focuses on operational excellence, compliance, and enhancing member experiences, requiring strong organizational skills and a background in care management.

Benefits

Medical, Dental, and Vision Benefits

401(k) Retirement Savings Plan

Paid Time Off

Short-term and Long-term Disability

Life Insurance

Qualifications

• 3+ years of Care Management Experience, focusing on development and compliance.
• Strong experience in problem-solving within complex environments.
• Ability to communicate effectively with senior leaders.

Responsibilities

• Support design and maintenance of operational model blueprints and documentation.
• Participate in business reviews and assist with submissions through approval processes.
• Conduct quality checks on documentation ensuring compliance and clarity.

Skills

Problem solving

Consulting

Facilitating teams

Communication

Influencing

Education

Bachelor's degree

Tools

Microsoft Office

Job description

Become a part of our caring community and help us put health first

The Care and Service Coordination Strategy and Growth Professional II supports the development and execution of Medicaid care/service coordination strategy and growth activities by partnering closely with Clinical Strategy Lead and Senior Professionals. This role helps bring strategy to life by translating high-level business goals and regulatory requirements into operational blueprints that support a scalable, repeatable implementation model.
The Strategy and Growth Professional II plays a key role in reviewing and interpreting the clinical model from the capture team and contracts, drafting operational model blueprints, and supporting developing of an operational vision. 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 Strategy and Growth 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.

The Strategy and Growth Professional II plays a key role in reviewing and interpreting the clinical model from the capture team and contracts, drafting operational model blueprints, and supporting developing of an operational vision. 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 Strategy and Growth 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.

• Support the development and maintenance of strategy documents such as operational model blueprints, lists of essential deliverables, and key business partners.
• 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.
• Participate in operational model 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.
• Research and gather information from contracts, regulatory documents, and internal stakeholders to support the development of operational models.
• 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.

Use your skills to make an impact

Required Qualifications

• 3+ Years of Care Management Experience, including process/program development, contracts, policies and procedures
• Comprehensive working knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint
• Experience problem solving and consulting within complex environments.
• Facilitating cross-functional teams in various departments in Medicaid and/or Medicare
• Strong influencing and process implementation skills.
• Ability to communicate effectively and deliver presentations to senior leaders

Preferred Qualifications

• Bachelor's degree
• Certified Case Manager
• Registered Nurse
• Licensed Social Worker

Additional Information

Work at Home Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

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.$65,000 - $88,600 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 06-15-2025

About us

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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.