Process Improvement Professional

Become a part of our caring community and help us put health first
 

Humana Healthy Horizons is seeking a Process Improvement Professional who analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable, and quantifiable business process improvements. The Process Improvement Professional work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. In this role, the professional must understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

The Process Improvement Professional roles and responsibilities include:

• Research best business practices within and outside the organization to establish benchmark data.

• Collect and analyze process data to initiate, develop, and recommend business practices and procedures that focus on enhanced safety, increased productivity, and reduced cost.

• Determine how new information technologies can support re-engineering business processes.

• May specialize in one or more of the following areas: benchmarking, business process analysis and re-engineering, change management and measurement, and/or process-driven systems requirements.

• Review of internal quality metrics.

• Support process improvement initiatives:

  • Assist in reviewing new Job Aids to support Training & Operations.

  • Review current Job Aids and Policies and Procedures as requested.

  • Create and present education as requested by the Process Improvement Lead. 

• Support Operations Managers in quality improvement initiatives:

  • Assist Managers in communicating audit findings to individuals and teams.

  • Communicate and manage remediation efforts with individuals.

  • Participates in Interrater Reliability (IRR) meetings and assists in the development of Interpretation Standards to guide audit scoring and increase consistency across the Process Improvement Team.

• Participate in root cause analysis research for audits.

Use your skills to make an impact
 

Required Qualifications

• Minimum three, (3), years working in a health-related environment.

• Minimum two, (2), years of experience related to process improvement, compliance measures, or auditing practices.

• Experience working within a health plan and understanding of Medicaid or Medicare guidelines.

• Proven oral / written communication and presentation skills.

• Excellent analytical skills, able to manipulate and interpret data.

• Exceptional organizational and prioritization skills.

• Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint.

• Ability to work within highly structured contractual time compliance requirements with occasional short turnaround time.

Work at Home Requirements

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

• Satellite, cellular and microwave connection can be used only if approved by leadership.

• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Preferred Qualifications

• Advanced degree

• Six Sigma or Process Improvement certifications.

• 2+ years of previous quality or process improvement experience in a hospital or physician office practice.

• Prior experience working with insurance claims, (utilization management, prior authorizations)

• Strong business skills, including sales and marketing objectives.

• Clinical background or physician office practice / hospital experience.

• Detail orientated and comfortable working with tight deadlines in a fast-paced environment.

Additional Information:

• Workstyle: Remote

• Travel:   Travel may be required to support state and federal audits.

• Core Workdays & Hours: Monday – Friday; typically, 8:00 AM to 5:00 PM Eastern Standard Time.

• Benefits: Benefits are effective on day 1. Full time Associates enjoy competitive pay and a comprehensive benefits package that includes 401k, Medical, Dental, Vision and a variety of supplemental insurances, tuition assistance and much more.  

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview.  If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided.  Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$65,000 - $88,600 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 05-01-2025

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.