LTSS Process Improvement Professional

This is a fully remote position, open to applicants in United States.

📋 Description

• Assist in the development and upkeep of implementation documents, encompassing policies, procedures, program outlines, correspondence, and assessments.

• Examine member and provider manuals for discrepancies and compliance deficiencies.

• Prepare and submit internal documentation following review and approval protocols.

• Oversee version control, file organization, and coordination with subject matter experts (SMEs) and reviewers.

• Evaluate training materials and job aids, providing constructive feedback to the training teams.

• Record process steps and design visual workflows.

• Aid in the creation and maintenance of clinical auditing tools and operational instruments.

• Establish and document shared mailboxes, fax numbers, and additional communication tools.

• Conduct research on contracts, regulatory documents, and information from internal stakeholders.

• Monitor document creation and submission tasks utilizing Smartsheet, OneNote, SharePoint, and internal project management systems.

• Engage in meetings, take notes, summarize discussions, and follow up on action items.

• Provide project assistance to the cohort team and contribute to broader process improvement initiatives.

• Interpret contract stipulations and translate them into summaries or draft documentation.

• Execute quality checks on documentation.

• Undertake stretch assignments and special projects aimed at supporting Medicaid implementation and process enhancements.

⛳️ Requirements

• Bachelor's degree or 3 years of equivalent experience in health plan operations.

• Over 2 years of experience supporting LTSS Provider, LTSS Care Management (CM), or LTSS Utilization Management (UM) roles.

• Project management experience is preferred.

• Experience with Medicare/Medicaid integrated models is preferred.

• Familiarity with working in a cross-functional environment is preferred.

• Minimum download speed of 25 Mbps for home internet access.

• Minimum upload speed of 10 Mbps for home internet access.

• A dedicated workspace free from interruptions to safeguard member PHI / HIPAA information.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Remote work options.

• Occasional travel to Humana offices for training or meetings.

• Home office work requirements supported by internet service criteria.