Senior Process Improvement Professional

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

📋 Description

• Oversee comprehensive process enhancement projects within D-SNP operations.

• Evaluate operational workflows, pinpoint underlying issues, and propose lasting solutions.

• Collaborate with business stakeholders, IT, compliance, claims, enrollment, customer service, and clinical teams.

• Create business requirements, process maps, and designs for future operational states.

• Track and enhance KPIs, service levels, quality metrics, and compliance results.

• Propel automation and modernization initiatives to minimize manual tasks and operational risks.

• Lead cross-functional meetings, decision-making processes, and change management activities.

• Assist in regulatory preparedness and compliance with CMS, state Medicaid, and Medicare standards.

• Deliver findings, recommendations, and executive summaries to leadership teams.

• Investigate best business practices and establish benchmark data.

• Gather and analyze process data to suggest enhanced business practices and procedures.

• Identify how new information technologies can aid in business process re-engineering.

⛳️ Requirements

• Experience with Dual Eligible Special Needs Plans (D-SNP), Medicare Advantage, Medicaid, or government healthcare programs.

• Understanding of CMS regulations and state Medicaid guidelines.

• 3-5+ years of experience in process improvement, operations, healthcare, or managed care.

• Excellent analytical and problem-solving capabilities.

• Proficient written and verbal communication skills, including experience with executive presentations.

• Familiarity with process mapping and documentation tools (Lucid, Visio).

• Knowledge of enrollment, eligibility, claims, care management, provider operations, or member services.

• Experience in root cause analysis and continuous improvement methodologies.

• Demonstrated ability to influence stakeholders without direct authority.

• Proven track record in leading complex, enterprise-wide initiatives and process redesign projects.

🏝️ Benefits

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

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability.

• Life insurance.

• Work-from-home arrangement.

• Dedicated workspace and internet requirements for home employees.