Care & Service Coordination Process Improvement Senior Professionals

Become a part of our caring community and help us put health first
 

The Senior Process Improvement Professional plays a pivotal role in driving the execution of new Medicaid implementations by owning the development of operational documentation and supporting readiness activities. This role is responsible for creating essential materials such as policies and procedures, program descriptions, member and provider communications, clinical workflows, and auditing tools that ensure compliance, accuracy, and operational alignment.

The individual in this position serves as a subject matter expert for their assigned cohort and is expected to exercise independent judgment and decision-making in their work. This includes leading the creation, internal review, and approval of implementation documents, as well as collaborating cross-functionally to provide feedback and support for training materials, business workflows, and stakeholder communications. The role also manages the setup of operational infrastructure such as shared mailboxes and fax numbers to support state-specific program launches.

A successful Senior Process Improvement Professional brings a passion for enhancing the member and provider experience, and can provide data-informed strategic direction to identify and address business needs. They support multi-functional teams by interpreting and translating complex contract requirements and state regulations into clear, actionable business deliverables. They ensure that policies and procedures align with the broader corporate vision, and are able to work with minimal supervision while making impactful decisions.

This role requires strong collaboration, attention to detail, and the ability to translate high-level strategy into execution-ready deliverables that support scalable, repeatable implementation models across multiple markets.

• Create and manage implementation materials that support our cohort SMEs for new and existing state implementations, including but not limited to policies and procedures, program descriptions, assessments, letters, training content, and workflow documentation.

• Lead the development, writing, editing, and updating of Medicaid policies and procedures, ensuring clarity, accuracy, alignment with contract requirements, and regulatory compliance.

• Conduct thorough reviews of member and provider manuals, ensuring alignment with internal operations and state expectations.

• Complete internal document reviews and manage the approval process, including routing through internal governance channels and submission to state partners as required.

• Review and provide feedback on training materials, working closely with the training team to ensure content is accurate, complete, and aligned with operational needs; provide formal approvals where appropriate.

• Own the business review and quality assurance of member and provider-facing materials, such as letters and assessments, ensuring they meet state-specific and business expectations.

• Create and document clinical workflows that support both cohort and non-cohort leads in translating strategic goals into repeatable, actionable processes.

• Develop clinical auditing tools to be used across all markets for monitoring compliance, identifying opportunities for improvement, and supporting quality assurance efforts.

• Build and manage shared mailboxes and fax numbers required for each new state implementation, ensuring access and proper routing for internal and external stakeholders.

• Collaborate with internal and external stakeholders to gather insights and ensure all deliverables are developed in alignment with the strategic direction set by the Process Improvement Leads.

• Maintain a comprehensive library of finalized documents, ensuring version control, accessibility, and alignment with recordkeeping and compliance expectations.

• Act as a key point of contact for document development, process readiness, and operational alignment for assigned state implementations.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree or equivalent work experience

• 3+ year process improvement experience

• 3+ years Care Management experience

• 2+ years workflow experience (ex: visio, lucid)

Preferred Qualifications

• LTSS experience

• Creating letters/assessments

• Business Requirement writing

Additional Information

This position is open to work remote anywhere

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 recommended; wireless, wired cable or DSL connection is suggested

• Satellite, cellular and microwave connection can be used only if approved by leadership

• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format  

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. 

If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn’t missed) If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. 

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. 

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

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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 05-20-2025

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.

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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.