Remote Process Improvement Specialist - Healthcare Ops

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

Job summary

Humana Inc. is seeking a Process Improvement Professional within the National Medicaid Operations Utilization Management Process Improvement & Enablement Team.

You will partner with Clinical Operations and clinical teams to standardize processes and ensure compliance with governing and NCQA requirements. The role analyzes existing workflows, develops repeatable improvements, and supports cross-functional implementation.

Qualifications

• Bachelor's degree or 3+ years relevant experience in lieu of degree.
• 3+ years of experience efficiently navigating multiple databases, systems, and screens simultaneously, with proficiency in collaboration platforms such as Zoom, Microsoft Teams, as well as Microsoft Office tools including Outlook, LUCID, Word, Excel, and PowerPoint.
• Prior experience in a fast-paced insurance or healthcare setting.
• Experience creating and maintaining compliant, user-friendly SharePoint sites.
• Medicare/Medicaid or Health Plan experience in Utilization Management is a plus.
• Power BI experience is preferred.

Responsibilities

• Initiate, develop, and recommend best practices for clinical and nonclinical teams.
• Standardizes Medicaid MD SOPs, workflows, and templates.
• Manages Medicaid MD controlled document updates (intake, versioning, approvals, publication).
• Coordinates Medicaid MD training/attestation and adoption.
• Establishes consistent practices to reduce variation across markets.
• Interprets policies to support compliant actions and decision-making.
• Executes on process improvement and evaluation strategies.
• Makes recommendations for improvement based on analysis of results.

Skills

Database navigation

Collaboration tools

Microsoft Office

Outlook

LUCID

Word

Excel

PowerPoint

Zoom

Microsoft Teams

SharePoint

Education

Bachelor's degree

Tools

Power BI

SharePoint

Job description

Humana Inc. is seeking a Process Improvement Professional within the National Medicaid Operations Utilization Management Process Improvement & Enablement Team.

You will partner with Clinical Operations and clinical teams to standardize processes and ensure compliance with governing and NCQA requirements. The role analyzes existing workflows, develops repeatable improvements, and supports cross-functional implementation.