Senior Process Improvement Professional

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

📋 Description

• Evaluate and assess the effectiveness of current business processes.

• Create sustainable, repeatable, and measurable improvements in business processes.

• Take ownership and provide leadership for strategic initiatives related to Medicaid enrollment and waiver modernization.

• Spearhead enhancements to enterprise member movement.

• Define requirements, perform testing, validate outcomes, and assist in implementation alongside IT and business stakeholders.

• Recognize operational risks and devise solutions to minimize impacts on clinical, claims, finance, and enrollment operations.

• Oversee post-implementation performance and business results.

• Exercise operational ownership and supervision for various Medicaid waiver enhancements.

• Govern processes related to LTSS waivers, including updates, validations, and issue resolution.

• Manage the LTSS mailbox and coordinate the review, validation, and processing of waiver-associated member information.

• Develop scalable processes aimed at reducing manual intervention and enhancing waiver data accuracy.

• Collaborate across business operations, technology, finance, claims, clinical, and enrollment teams.

• Facilitate alignment among stakeholders on priorities, requirements, testing, implementation, and operational readiness.

• Provide updates on project progress, risks, dependencies, and recommendations to leadership.

• Assist in training, change management, and adoption initiatives.

• Identify opportunities for automation and establish monitoring, reporting, and governance practices.

• Support enterprise Medicaid operations and initiatives for enrollment modernization.

⛳️ Requirements

• Proven experience in leading complex healthcare, Medicaid, process improvement, operational, or technology initiatives.

• Demonstrated success in managing cross-functional projects that involve multiple business areas.

• Strong analytical, problem-solving, and risk management skills.

• Experience in developing business requirements, testing strategies, operational processes, and implementation plans.

• Preferred experience in Medicaid managed care, enrollment, eligibility, waiver, or member administration.

• Experience with Medicare and/or Medicaid is preferred.

• Preferred familiarity with Medicare Reconciliation.

• Experience in analyzing, interpreting, and presenting financial, health, competitive, and performance measurement data is preferred.

• Experience in leading strategy and/or operational planning is preferred.

• Experience in consulting with and/or influencing executive leadership is preferred.

• Proven ability to influence change within a matrix organization is preferred.

• Familiarity with Microsoft Excel, including chart creation, macros, and pivot tables is preferred.

• Experience with Power BI is preferred.

• Minimum home internet speed of 25 Mbps download and 10 Mbps upload for remote or hybrid home/office employees.

• Ability to work from a dedicated space free from ongoing interruptions to protect 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.

• Personal wellness support and resources for making informed healthcare decisions.