Remote 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

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.