Process Improvement Professional - National Clinical Ops Medicaid

Humana • Indianapolis, SC

1d • $65,000 - $88,600 • Remote

About The Position

This role, within the National Medicaid Operations Utilization Management Process Improvement & Enablement Team, will partner closely with Clinical Operations, subject matter experts, and clinical teams to support Medicaid Medical Directors. The position is responsible for ensuring clinical operational processes are standardized, effective, and aligned with applicable governing and NCQA requirements. The Process Improvement Professional analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable, and quantifiable process improvements. This role requires the ability to interpret complex information, assess operational needs, and independently determine appropriate courses of action. Work assignments are varied and may involve cross-functional collaboration, process development, implementation support, and ongoing evaluation of process performance.

Requirements

• 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.

Nice To Haves

• Previous Medicare/Medicaid or Health Plan experience in Utilization Management
• Power BI experience

Responsibilities

• Responsible for initiating, developing, and recommending best business practices and procedures for physical health clinical and nonclinical teams
• Standardizes and maintains Medicaid MD operating procedures (SOPs), workflows, and templates
• Manages Medicaid MD controlled document updates (intake, versioning, approvals, publication)
• Coordinates Medicaid MD training/attestation and adoption.
• Establishes consistent practices for Medicaid MD procedures to reduce variation across markets.
• Interprets organizational policies and procedures to determine appropriate actions, ensure compliance, and support effective decision-making.
• Executes on process improvement/development and evaluation strategy and analyzes results.
• Makes recommendations for improvement based on analysis of results.

Benefits

• medical
• dental
• 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