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Humana Illinois Market is seeking a Process Improvement Professional who analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable, and quantifiable business process improvements. The Process Improvement Professional will work with the oversight of the Critical Incidents reported. This oversight process was recognized as a best practice by the Illinois Association of Medicaid Health Plans in 2024 and was awarded their APEX award. Oversight requirements are varied and frequently require interpretation and independent determination of the appropriate courses of action. In this role, the professional must understand department, segment, and organizational strategy and operating objectives, including their linkages to related areas..

Job Description

Position Responsibilities:

• Collaborate with the Care Coordinators assigned to the case to determine strategies to mitigate further risk to the member.
• Monitor Care Coordination activity and documentation regarding the Critical Incident.
• Collaborate with Leadership staff as needed regarding closure of Critical Incidents.
• Provide oversight for quarterly State audits of Critical incidents.
• Provide reporting to the Illinois Quality Improvement Committee on Critical Incidents and support Annual Quality report.
• Prepare monthly reports to the State regarding Critical Incidents.
• Provide training as needed for new hires and current staff on updates to CIs
• Perform audits focused on improving compliance and quality.
• Review new Critical Incident entries for appropriateness to be classified as a Critical Incident according to guidelines submitted by Illinois oversight agencies
• Development and review of internal quality metrics.
• Support process improvement initiatives. Assist in reviewing new Job Aids to support the team of Learning Design and Learning Facilitation staff.
• Review current Job Aids and Policies and Procedures as requested.
• Create and present education as requested by the Process Improvement Manager.
• 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

• Bachelor's degree
• 2 years of experience related to process improvement, compliance measures, or auditing practices or 2 years of experience in Medicaid/Medicare Care Coordination
• Experience in Care Coaching and/or Care Coordination
• Proven oral / written communication and presentation skills.
• Excellent analytical skills, able to manipulate and interpret data

Preferred Qualifications:

• Knowledge of Critical Incident reporting
• Experience in Medicaid or Medicare Guidelines.
• Detail orientated and comfortable working with tight deadlines in a fast-paced environment

Additional Information

• Workstyle: Remote
• Core Workdays & Hours: Monday – Friday; typically, 8:00am – 5:00pm Central Standard Time.

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 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 a