Remote LTSS Process Improvement Specialist

Humana Inc; Northern (KY); Remote; USD 65,000 - 89,000; Full time

Job summary

Humana Inc. is seeking a Process Improvement Professional II to support Medicaid implementation activities.

You will develop policies, procedures, and readiness materials, coordinating with senior staff to ensure compliance and alignment with contracts across new markets. The role emphasizes documentation, workflow development, and cross-functional collaboration to enhance member and provider experiences while maintaining quality and regulatory readiness.

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.
• Experience/knowledge working in a cross-functional settings.

Responsibilities

• Support development and maintenance of implementation documents by drafting and editing before submission to Senior Professionals or Leads.
• Assist in reviewing member and provider manuals for inconsistencies or compliance gaps.
• Prepare and submit internal documentation through review and approval processes with proper version control.
• Collaborate with Senior Process Improvement Professional to review training materials and provide clarifying information to the training team.
• Document process steps and build initial drafts for workflows to be reviewed by Senior Professional or Lead.
• Support creation and maintenance of clinical auditing tools and operational tools used across markets.
• Research and gather information from contracts and regulatory documents to support development of implementation materials.
• Track progress on documentation tasks using Smartsheet/OneNote/SharePoint and meet deadlines.

Skills

Project management

Cross-functional collaboration

Healthcare operations

Education

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

Tools

Smartsheet

OneNote

SharePoint

Job description

Humana Inc. is seeking a Process Improvement Professional II to support Medicaid implementation activities.

You will develop policies, procedures, and readiness materials, coordinating with senior staff to ensure compliance and alignment with contracts across new markets. The role emphasizes documentation, workflow development, and cross-functional collaboration to enhance member and provider experiences while maintaining quality and regulatory readiness.