LTSS Process Improvement Professional

Become a part of our caring community
 

The Process Improvement Professional supports the development and execution of Medicaid implementation activities by partnering closely with Process Improvement Leads and Senior Professionals. This role helps bring strategy to life by translating high-level business goals and regulatory requirements into operational documentation and tools that support a scalable, repeatable implementation model.

 The Process Improvement Professional plays a key role in drafting and reviewing policies and procedures, program descriptions, workflows, training content, and other readiness materials required for new state launches. They support business reviews of member and provider-facing documents, assist with document submissions through internal approval processes, and help ensure alignment with contract requirements and the overall strategic vision.

 This professional contributes to initiatives that solve complex business challenges through research, collaboration, and thoughtful documentation. While work assignments are varied and may require independent interpretation and action, the role works under the guidance of senior team members and collaborates cross-functionally to ensure consistency and accuracy in deliverables. They are essential to ensuring quality, compliance, and operational readiness across all new Medicaid markets.

 A successful Process Improvement Professional II is detail-oriented, organized, and passionate about enhancing the member and provider experience. They will support strategic planning through documentation, workflow development, and process alignment, ensuring that all deliverables reflect Humana’s commitment to excellence, compliance, and person-centered care.

Position Responsibilities:  

• Support the development and maintenance of implementation documents such as policies and procedures, program descriptions, letters, and assessments by drafting, editing, formatting, and conducting preliminary reviews before submission to Senior Professionals or Leads. 
• Assist in reviewing member and provider manuals, flagging inconsistencies or compliance gaps, and supporting alignment with state requirements. 
• Prepare and submit internal documentation through established review and approval processes, ensuring proper version control, file management, and coordination with SMEs and reviewers. 
• Collaborate with the Senior Process Improvement Professional to review training materials and job aids, offering feedback based on document content and providing clarifying information to the training team as needed. 
• Participate in workflow development activities by documenting process steps, creating visual workflows, and helping build initial drafts to be reviewed and finalized by the Senior Professional or Lead. 
• Support the creation and maintenance of clinical auditing tools and other operational tools that will be used across markets, ensuring consistency and accessibility. 
• Assist in the setup and documentation of shared mailboxes, fax numbers, and other communication tools for new state implementations. 
• Research and gather information from contracts, regulatory documents, and internal stakeholders to support the development of implementation materials. 
• Track progress on document creation and submission tasks using internal project tracking systems (e.g., Smartsheet, OneNote, SharePoint), ensuring deadlines and deliverables are met. 
• Participate in meetings and working sessions with Senior Professionals and Leads to take notes, summarize discussions, and follow up on assigned tasks. 
• Provide general project support to the cohort team and contribute to broader team efforts aimed at process improvement and operational readiness. 
• Assist in interpreting contract requirements and converting them into clear and understandable summaries or draft documentation for review by senior team members. 
• Perform quality checks on documentation to ensure clarity, formatting, and alignment with submission standards. 
• Take on stretch assignments or special projects to support business readiness and further develop expertise in Medicaid implementation and process improvement. 

Use your skills to make an impact
 

Required Qualifications: 

·         Bachelor's degree or 3 years’ equivalent experience working in health plan operations.

·         2 plus years’ experience supporting LTSS Provider, LTSS Care Management (CM), or LTSS Utilization Management (UM) roles.

Preferred Qualifications: 

o    Project management experience. 

o    Medicare/Medicaid integrated model experience.

o    Experience/knowledge working in a cross-functional settings. 

Additional Information

Location: Remote US

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. 

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.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 yearThis 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 10-09-2026

About us
 

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.

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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.