Process Improvement Lead - Medicaid/DSNP Implementations

Become a part of our caring community and help us put health first
 The Process Improvement Lead analyzes, and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

The Clinical Operations (CO) Team establishes Humana’s enterprise clinical direction, identifying, evaluating and communicating the strategies that will help our members receive superior healthcare access and outcomes, while driving down associated costs. 

This role, within the Integrated Business Advancement (IBA) Process Optimization team of CO, will work closely with CO leaders and SMEs in the areas of Utilization Management (inpatient & outpatient), Care Management, Quality Operations and Market relations as well as key aligned partners in leading and delivering on initiatives and process capabilities that enable improved effectiveness, efficiency and experiences (member, provider and associate). The Lead defines improvement projects aligned with business strategies and CO priorities.

Key Responsibilities:

The successful candidate will lead, facilitate and support effective implementation of DSNP and Medicaid plans specific to Clinical Operations Medicare UM impacts in support of the Enterprise Medicaid/DSNP growth pipeline. This includes, but is not limited to, the following:

• Develop and leverage a streamlined implementation model to support effective collaboration and communication across cross-functional teams
• Create simplified tools to make it easier for the associates doing the work
• Lead and facilitate dedicated working sessions to support delivery and end-to-end solutions
• Provide clear and timely communications with the implementation team and key cross-functional teams/leaders throughout the life cycle of the implementation
• Serve as the primary point of contact from an UM perspective for Medicaid and DSNP post implementation support to address gaps/issues and capture lessons learned to drive continuous improvement in future implementations
• Lead efforts to bring DSNP and Medicaid state implementation support for UM and CM together to improve coordination and implementation across Clinical Operations
• Lead DSNP and Medicaid implementations to support the Enterprise Medicaid/DSNP growth pipeline

The candidate will be expected to provide the following support to meet ongoing business needs across the organization:

• Provide leadership and mentorship to other team members and business partners across IBA to cultivate a continuous improvement culture throughout the organization
• Builds collaborative business partnerships which bring clarity to the organization and facilitates effective change
• Execute process initiatives highlighting KPIs that provide observations, insights and recommendations on actions to be taken
• Further simplify and improve processes that are informed by the ideal member, provider and associate experience, and are enabled through both technology and non-technology solutions

Use your skills to make an impact
 

Required Qualifications

• 6 or more years of consulting and/or process improvement experience
• 2 or more years of cross-functional project leadership experience
• Strong business acumen balanced with analytical skills to see the big picture and draw out insights and observations
• Demonstrated ability to manage timelines and competing priorities while effectively communicating and collaborating across multiple departments
• Advanced proficiency with Microsoft applications (Word, Excel, PowerPoint)
• Demonstrated success with accountability / ownership of responsibilities
• Excellent interpersonal, organizational, communication and presentation skills
• Comfortable working in a fast paced, highly complex organization
• Ability to effectively interact with and influence all levels of the organization

Preferred Qualifications

• Bachelor's Degree in Nursing, Business, Engineering or another related field
• Medicaid and/or DSNP experience
• Clinical Operations UM experience
• CGX Experience
• Clinical process improvement experience
• Strong with data analysis and telling a story to business customers with data
• MBA
• Lean / Six Sigma Green / Black Belt certification

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.

 

$94,900 - $130,500 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: 04-13-2025
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.

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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.

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