Become a part of our caring community and help us put health first
 Humana Healthy Horizons in Virginia is looking for Process Improvement Professionals to analyze and measure the effectiveness of existing business processes and develops sustainable, repeatable, and quantifiable business process improvements. The Process Improvement Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Process Improvement Professional 2 must understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

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.
Use your skills to make an impact
 

Required Qualifications

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.

Preferred Qualifications

Registered Nurse (RN) or bachelor's degree or advanced degree in social work.Knowledge of HEDIS/Stars/CMS/Quality.Experience in Medicaid or Medicare Guidelines.Strong business skills, including sales and marketing objectives.Detail orientated and comfortable working with tight deadlines in a fast-paced environment.

Additional Information

Workstyle: This is a remote position with some travel.Travel:  Some travel is required to support state and federal audits, face-to-face collaborations and meetings in the Humana Healthy Horizons office in Glen Allen, VA and the Department of Medical Assistance Services (DMAS).Workdays & Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).

WAH Internet Statement

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.Satellite, cellular and microwave connection can be used only if approved by leadership.Humana will provide Home or Hybrid Home/Office employees 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.

Interview Format

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

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.

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.