Remote LTSS Process Improvement Specialist

Humana Inc; Lincoln (NE); Remote; USD 65,000 - 89,000; Full time

Job summary

Humana Inc is seeking a Process Improvement Professional II to support Medicaid implementation activities by partnering with Process Improvement Leads and Senior Professionals. You will translate state contracts and regulatory requirements into operational documentation, workflows, and training materials to enable scalable, compliant readiness across markets.

You'll draft policies, review member and provider documents, manage version control, and collaborate across functions to ensure accuracy

Qualifications

• Bachelor's degree or 3 years’ equivalent experience working in health plan operations.
• 2 plus years’ experience supporting LTSS Provider, LTSS Care Management (CM), or LTSS Utilization Management (UM) roles.

Responsibilities

• Draft and review policies and procedures, program descriptions, workflows, training content, and readiness materials required for new state launches.
• Review member and provider manuals, flag inconsistencies or compliance gaps, and align with state requirements.
• Prepare and submit internal documentation through established review and approval processes, ensuring proper version control and file management.
• Collaborate with Senior Process Improvement Professional to review training materials and job aids, providing clarifying information as needed.
• Document process steps, create visual workflows, and help build initial drafts for final review by Senior Professional or Lead.
• Assist in creating and maintaining clinical auditing tools and other operational tools for use across markets.
• Research and gather information from contracts and regulatory documents to support implementation materials.
• Track progress on document creation and submission tasks in internal project systems to meet deadlines.

Education

Bachelor's degree or 3 years’ equivalent experience in health plan operations

Job description

Humana Inc is seeking a Process Improvement Professional II to support Medicaid implementation activities by partnering with Process Improvement Leads and Senior Professionals. You will translate state contracts and regulatory requirements into operational documentation, workflows, and training materials to enable scalable, compliant readiness across markets.

You'll draft policies, review member and provider documents, manage version control, and collaborate across functions to ensure accuracy