Lead, LTSS Process Improvement

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

The Medicaid Long-Term Supports and Services (LTSS) Process Improvement Lead analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements and best practices. The LTSS Process Improvement Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

The LTSS Medicaid Process Improvement Lead researches 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. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action.

Position Responsibilities :

Program Enhancement :

Analyze current Medicaid long-term support and services programs to identify areas for improvement.

Research, analyze, and interpret state contracts and responses.

Develop and implement strategies to enhance program efficiency, ensuring optimal utilization of resources.

Description Management :

Oversee the creation, review, and update of program descriptions to align with evolving Medicaid requirements.

Collaborate with relevant stakeholders to ensure accuracy and completeness of program descriptions.

Policy and Procedure Oversight :

Interpret complex regulations and process to translate them into easily understandable policies and procedures.

Establish and maintain policies and procedures governing Medicaid long-term supports and services.

Lead the development, writing, editing, and updating of Medicaid policies and procedures, ensuring clarity, accuracy, and alignment with regulatory requirements.

Process Optimization :

Lead initiatives to streamline processes related to Medicaid services, reducing administrative burden, and enhancing service delivery.

Stakeholder Collaboration :

Collaborate with internal teams, external partners, and Medicaid agencies to ensure alignment with program goals and objectives.

Act as a liaison between the organization and regulatory bodies, fostering positive relationships.

Lead by influence, both internal and external team members, to create policy and procedures, including training and mentoring.

Use your skills to make an impact

Required Qualifications :

Bachelor's degree in Business or a related field AND a minimum five (5) years business experience

Experience in Managed care health plan operations

Strong influencing and process implementation skills

Facilitating and driving cross-functional teams' efforts

Successfully demonstrated delivering presentations to senior leaders

Must be available to work normal business hours in the Eastern Standard Time Zone

Available for 10% travel to the Virginia office for meetings and or trainings on a quarterly basis

Preferred Qualifications :

Master's degree in Business, Operations Management, Healthcare Administration

2+ years in project leadership

Knowledge of Systems Development Life Cycle, Waterfall, and Agile Development Methodologies

Possess a solid understanding of operations, technology, communications and processes Six Sigma and / or Project Management Institute certification

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 recommended; wireless, wired cable or DSL connection is suggested

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

Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

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, 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 an email correspondence inviting you to participate in a pre-recorded Voice Interview and / or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn't missed) 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 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.

$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 : 02-12-2026

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 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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our