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Process Improvement Professional

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Humana

17d ago

  • Job
    Full-time
    Junior Level
  • Healthcare
  • Virginia
    Remote

AI generated summary

  • You must reside in Virginia, have a Bachelor's degree or active LPN license, 2+ years in process improvement, clinical experience, and strong skills in Microsoft Office, analysis, and communication.
  • You will analyze processes, conduct audits, support quality initiatives, develop metrics, create educational materials, and assist in root cause analysis to enhance efficiency and compliance.

Requirements

  • Must reside in the Commonwealth of Virginia.
  • Bachelor's degree OR an active LPN license in the Commonwealth of Virginia without disciplinary action.
  • Two (2) or more years of professional experience related to process improvement, compliance measures, or auditing practices.
  • Clinical background in working with a health plans or hospital settings.
  • Comprehensive knowledge of Microsoft Office Word, Excel, and PowerPoint.
  • Excellent analytical skills, able to manipulate and interpret data.
  • Proven oral / written communication and presentation skills.
  • Exceptional organizational and prioritization skills.
  • Ability to work within highly structured contractual time compliance requirements with occasional short turnaround time.

Responsibilities

  • Research best business practices within and outside the organization to establish benchmark data.
  • Collects and analyzes process data to initiate, develop, and recommend business practices and procedures that focus on enhanced safety, increased productivity, and reduced cost.
  • Determines 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.
  • Performs audits focused on improving compliance and quality.
  • Focus audits – including annual and initial HRA compliance, post discharge and transition of care contacts.
  • Develops and reviews internal quality metrics.
  • Supports process improvement initiatives.
  • Assists in reviewing new Job Aids to support the Training & Operations team of Learning Design and Learning Facilitation staff.
  • Reviews current Job Aids and Policies and Procedures as requested.
  • Creates and presents education as requested by the Process Improvement Lead.
  • Supports Operations Managers in quality improvement initiatives.
  • Assists Managers in communicating audit findings to individuals and teams.
  • 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.
  • Participates in root cause analysis research for audits.
  • Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed.

FAQs

Do we support remote work?

Yes, this is a remote position with some travel required.

What are the required qualifications for this position?

Candidates must reside in Virginia, possess a Bachelor's degree or an active LPN license in Virginia without disciplinary action, have two or more years of professional experience related to process improvement or auditing, and have a clinical background in working with health plans or hospital settings.

Are there any preferred qualifications for this job?

Yes, preferred qualifications include being a Registered Nurse (RN) or holding a bachelor's or advanced degree in social work, knowledge of HEDIS/Stars/CMS/Quality, experience with Medicaid or Medicare guidelines, and strong business skills related to sales and marketing objectives.

What are the working hours for this role?

The working hours are Monday to Friday from 8:00 am to 5:00 pm Eastern Standard Time (EST).

Is travel required for this position?

Yes, some travel is required to support state and federal audits and for face-to-face collaborations and meetings in the Humana Healthy Horizons office in Glen Allen, VA.

What type of internet connection is required for remote employees?

Remote employees must have a minimum download speed of 25 Mbps and an upload speed of 10 Mbps, with a wired cable or DSL connection suggested.

What benefits are offered by Humana for this position?

Humana offers competitive benefits including medical, dental, and vision coverage, a 401(k) retirement savings plan, paid time off, short-term and long-term disability, life insurance, and other opportunities for personal wellness.

What is the pay range for this position?

The pay range for this position is $65,000 to $88,600 per year, and it is eligible for a bonus incentive plan based on performance.

How does Humana ensure equal opportunity in employment?

Humana is committed to not discriminating against any employee or applicant based on various protected statuses, and it takes affirmative action to employ and advance all persons regardless of those statuses.

What skills are necessary for a Process Improvement Professional?

Necessary skills include excellent analytical skills to manipulate and interpret data, strong oral and written communication abilities, exceptional organizational skills, and the ability to work within structured time compliance requirements.

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Humana

Science & Healthcare
Industry
1001-5000
Employees
1961
Founded Year

Mission & Purpose

At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.