Process Improvement Professional – National Clinical Ops, Medicaid

This is a fully remote position, open to applicants in Florida, +7 more states.

📋 Description

• Collaborate closely with Clinical Operations, subject matter experts, and clinical teams to assist Medicaid Medical Directors.

• Ensure that clinical operational processes are standardized, effective, and compliant with governing and NCQA standards.

• Evaluate and measure the effectiveness of current business processes.

• Create sustainable, repeatable, and measurable process enhancements.

• Initiate, develop, and suggest optimal business practices and procedures for both physical health clinical and nonclinical teams.

• Standardize and uphold Medicaid Medical Director operating procedures, workflows, and templates.

• Oversee controlled document updates, which include intake, versioning, approvals, and publication.

• Organize training, attestation, and adoption for Medicaid Medical Directors.

• Establish uniform procedures to minimize variation across different markets.

• Interpret organizational policies and procedures to determine suitable actions and maintain compliance.

• Implement strategies for process improvement, development, and evaluation.

• Analyze outcomes and recommend enhancements.

• Collaborate across functions on process development and support for implementation.

• Occasionally travel to Humana offices for training or meetings.

⛳️ Requirements

• Bachelor's degree or 3+ years of relevant experience in place of a degree.

• 3+ years of experience effectively navigating multiple databases, systems, and screens at the same time.

• Proficiency in Zoom and Microsoft Teams.

• Proficiency in Microsoft Office applications, including Outlook, LUCID, Word, Excel, and PowerPoint.

• Previous experience in a fast-paced insurance or healthcare environment.

• Experience in creating and maintaining compliant, user-friendly SharePoint sites.

• Ability to interpret complex information and evaluate operational needs.

• Preferred: Prior experience in Medicare/Medicaid or Health Plan roles within Utilization Management.

• Preferred: Experience with Power BI.

• Minimum home internet download speed of 25 Mbps and upload speed of 10 Mbps.

• Ability to work from a designated area without interruptions to safeguard member PHI/HIPAA information.

🏝️ Benefits

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

• Medical, dental, and vision coverage.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental and caregiver leave.

• Short-term disability coverage.

• Long-term disability coverage.

• Life insurance.

• Comprehensive wellness support.

• Remote work arrangement.

• Specific home workspace and internet requirements to facilitate effective remote work.