Process Improvement Lead, Medicaid

Humana • Columbia, SC

2d • Onsite

About The Position

The Process Improvement Lead analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Lead works on problems of diverse scope and complexity ranging from moderate to substantial. You will report to the Director of Health Services and have 1-2 direct reports. The Process Improvement Lead is responsible for developing and executing operational excellence initiatives within the organization. This role uses structured methodologies to identify inefficiencies, recommend solutions, and drive implementation of best practices across business processes. The Process Improvement Lead will research best business practices within and outside the organization to establish benchmarks for the team. You will review processes and procedures, work to streamline the department, ensuring better collaboration, efficiency and compliance. You will design and build out new processes and practices for the team. Act as the point person for the department regarding resources, policies and procedures such as compliance, audits, quality reviews like NCQA materials. In this role, you will also collect and analyze data, identifying gaps and building out process and procedures to develop best practices while minimizing risk. You will review job aids, new hire onboarding and training process to ensure the team is following best in class business practices and procedures that focus on enhanced safety, increased productivity and reduced cost. You may advise leadership to develop functional strategies (often segment specific) on matters of significance. Use your skills to make an impact.

Requirements

• Bachelor's degree
• 5 or more years of process improvement experience
• 2 or more years of project leadership experience
• 2 or more years of experience in case management and/or utilization management experience

Nice To Haves

• Active Registered Nurse (RN) or Master of Social Work (MSW) license in the state of employment
• Experience with Medicaid compliance preferred
• At least 2 years of Medicaid experience
• Certification in Lean, Six Sigma, or a comparable process improvement methodology preferred
• Ability to lead multiple initiatives and drive change within a matrixed organization
• Familiarity with project management tools and resources

Responsibilities

• Analyzes and measures the effectiveness of existing business processes.
• Develops sustainable, repeatable and quantifiable business process improvements.
• Develops and executes operational excellence initiatives within the organization.
• Uses structured methodologies to identify inefficiencies, recommend solutions, and drive implementation of best practices across business processes.
• Researches best business practices within and outside the organization to establish benchmarks for the team.
• Reviews processes and procedures to streamline the department, ensuring better collaboration, efficiency and compliance.
• Designs and builds out new processes and practices for the team.
• Acts as the point person for the department regarding resources, policies and procedures such as compliance, audits, quality reviews like NCQA materials.
• Collects and analyzes data, identifying gaps and building out process and procedures to develop best practices while minimizing risk.
• Reviews job aids, new hire onboarding and training process to ensure the team is following best in class business practices and procedures that focus on enhanced safety, increased productivity and reduced cost.
• Advises leadership to develop functional strategies (often segment specific) on matters of significance.

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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level