Senior Process Improvement Professional

Humana • South Bend, IN

2d • Remote

About The Position

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.

Requirements

• 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.

Nice To Haves

• 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.

Responsibilities

• Lead process improvement initiatives supporting the Michigan Long-Term Services and Supports (LTSS) program.
• Analyze existing processes, identify opportunities for improvement, and develop sustainable solutions.
• 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.

Benefits

• medical
• dental
• vision
• 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: Senior