Remote Medicaid Process Improvement Professional

Humana Inc; Cheyenne (WY); Remote; USD 65,000 - 89,000; Full time

Benefits offered by this job

Bonus eligibility

Job summary

Humana Inc. is seeking a Process Improvement Professional II to support Medicaid implementation activities and ensure readiness across new markets. You will draft policies, review workflows, and coordinate with senior staff to translate business goals into executable documentation.

Remote role in the US with travel as needed, typical 40-hour weeks, and a base pay range reflected in Humana's guidelines. This position emphasizes compliance, quality, and cross-functional collaboration.

Qualifications

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

Responsibilities

• Support the development and maintenance of implementation documents such as policies and procedures, program descriptions, letters, and assessments by drafting, editing, formatting, and conducting preliminary reviews before submission to Senior Professionals or Leads.
• 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.
• Collaborate with the Senior Process Improvement Professional to review training materials and job aids, offering feedback based on document content and providing clarifying information to the training team as needed.
• Participate in workflow 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.
• Assist in the setup and documentation of shared mailboxes, fax numbers, and other communication tools for new state implementations.
• Research and gather information from contracts, regulatory documents, and internal stakeholders to support the development of implementation materials.
• 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.

Education

Bachelor's degree or 3 years’ equivalent 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 and ensure readiness across new markets. You will draft policies, review workflows, and coordinate with senior staff to translate business goals into executable documentation.

Remote role in the US with travel as needed, typical 40-hour weeks, and a base pay range reflected in Humana's guidelines. This position emphasizes compliance, quality, and cross-functional collaboration.