Senior Process Improvement Professional

Humana Inc; Michigan; Hybrid; USD 78,000 - 108,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Job summary

Humana Inc. is seeking a Senior Process Improvement Professional to lead LTSS process improvements across HCBS, care management, utilization management, and quality initiatives in Michigan.

You will analyze current workflows, identify improvement opportunities, and develop sustainable solutions that enhance member experience, compliance, and contract performance. You will partner with Care Management, Utilization Management, Quality, Reporting, Provider, and Compliance teams to redesign

Qualifications

• Bachelor's degree required.
• 3+ years in process improvement, healthcare operations, quality improvement, or related field.
• Experience with healthcare, managed care, Medicaid, LTSS, HCBS, or population health.
• Experience interpreting operational and performance data to drive business decisions.
• Advanced proficiency with Microsoft Office (Excel and PowerPoint).
• Excellent verbal and written communication, with experience presenting to leadership teams.

Responsibilities

• Lead process improvement initiatives supporting LTSS, HCBS, care management, utilization management, quality, reporting and operational workflows.
• Analyze LTSS operational workflows and identify opportunities to improve efficiency, quality, compliance and member outcomes.
• Partner with Care Management, Utilization Management, Quality, Reporting, Provider, and Compliance teams to support process redesign and implementation efforts.
• Develop standardized LTSS workflows, policies, procedures, audit tools, and process documentation.
• Monitor Michigan contract requirements and support operational changes necessary to maintain LTSS compliance.
• Conduct root cause analysis of issues, performance gaps, audit findings, grievances, appeals, and quality concerns.

Skills

Process improvement

Healthcare operations

Quality improvement

Project management

Data interpretation

Communication

LTSS

Education

Bachelor's degree

Tools

Microsoft Office

Job description

Become a part of our caring community The Senior Process Improvement Professional leads process improvement initiatives supporting the Michigan Long-Term Services and Supports (LTSS) program, including Home and Community-Based Services (HCBS), care management, utilization management, quality, reporting, and operational workflows. You will analyze existing processes, identify opportunities for improvement, and develop sustainable solutions that enhance member experience, regulatory compliance, operational efficiency, and contract performance. Analyze LTSS operational workflows and identify opportunities to improve efficiency, quality, compliance, and member outcomes. Partner with Care Management, Utilization Management, Quality, Reporting, Provider, and Compliance teams to support process redesign and implementation efforts. Develop standardized LTSS workflows, policies, procedures, audit tools, and process documentation. Monitor Michigan contract requirements and support operational changes necessary to maintain LTSS compliance. Conduct root cause analysis of operational issues, performance gaps, audit findings, grievances, appeals, and quality concerns. Use data and reporting to identify trends, develop recommendations, and measure the effectiveness of process improvements. Facilitate training, process mapping, workflow redesign, and change management initiatives across LTSS functions. Support implementation of state-directed initiatives, regulatory changes, EVV-related processes, assessment requirements, and LTSS program enhancements. Develop key performance indicators and monitoring tools to evaluate process outcomes and operational effectiveness. Research industry best practices and emerging trends related to Medicaid, HCBS, LTSS, care coordination, and quality improvement. Prepare LTSS presentations, reports, and executive summaries for leadership and stakeholders. Serve as a subject matter resource for continuous improvement methodologies and operational excellence initiatives. Use your skills to make an impact.

Required Qualifications

• Must reside in Michigan or within a 40-mile radius of the Michigan border in Ohio or Indiana.
• Bachelor's degree.
• Three (3) or more years of experience in process improvement, healthcare operations, quality improvement, project management, or a related field.
• Experience working with healthcare, managed care, Medicaid, LTSS, HCBS, or population health programs.
• Experience interpreting operational and performance data to drive business decisions.
• Demonstrated expertise in analyzing business processes, identifying root causes, and implementing effective process improvements to enhance performance and efficiency.
• Advanced proficiency with Microsoft Office applications, including Excel and PowerPoint.
• Excellent verbal and written communication skills, with experience presenting process improvement opportunities, project updates, and performance metrics to leadership teams.

Preferred Qualifications

• Master's degree in healthcare administration, business administration, public health, or related field.
• Lean, Six Sigma, PMP, or other process improvement certification.
• Experience with Michigan Medicaid and Long-Term Services and Supports (LTSS) programs.
• Knowledge of Michigan Home and Community-Based Services (HCBS) waiver requirements and regulatory standards.
• Experience supporting state contract compliance, audits, or quality improvement initiatives.

Additional Information

Workstyle: This is a remote position with some travel.

Travel: Up to 10% travel, including periodic visits to Humana's Detroit, Michigan office for team engagement and collaborative meetings.

Typical Work Schedule: Monday through Friday; 8:00 AM to 5:00 PM Eastern Time (ET).

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours 40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$78,400 - $107,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

• Medical, dental and vision benefits
• 401(k) retirement savings plan
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• Short-term and long-term disability
• Life insurance
• Many other opportunities.

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About us

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large.

Learn more about what we offer atHumana.comand atCenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.