Senior Process Improvement Professional, Care and Service Coordination Strategy & Growth

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

The Care and Service Coordination Strategy and Growth Senior Professional plays a pivotal role in designing and execution of Medicaid care/service coordination strategy and growth activities for Medicaid and dual Medicare/Medicaid plans (dual eligible special needs plans (DSNP) by partnering closely with Care and Service Coordination Strategy Principal and Care and Service Coordination Strategy Professionals, Process Improvement Teams, national Medicare partners, and market-based leadership teams. This role helps bring strategy to life by translating high-level business goals and regulatory requirements into operational blueprints that support a scalable, repeatable implementation model.
The Senior Strategy and Growth Professional plays a key role in reviewing and interpreting the clinical model from the capture team and contracts, drafting operational model blueprints, and supporting developing of an operational vision. They contribute to initiatives that solve complex business challenges through research, collaboration, and thoughtful documentation.
Work assignments are varied and require independent judgement and decision-making. The Senior Professional role requires strong collaboration, including collaboration with and providing guidance to junior team members of the Care and Service Coordination Strategy and Growth Team. They are essential to ensuring successful operational design, quality, and across all new Medicaid markets, including duals Medicare/Medicaid (DSNP) markets.
A successful Senior Strategy and Growth Professional is detail-oriented, organized, and passionate about enhancing the member and provider experience. They will support strategic planning through documentation, workflow development, and process alignment, ensuring that all deliverables reflect Humana’s commitment to excellence, compliance, and person-centered care.

• Support the development and maintenance of strategy documents such as operational model blueprints, lists of essential deliverables, and key business partners.
• Assist in reviewing member and provider manuals, flagging inconsistencies or compliance gaps, and supporting alignment with state requirements.
• Prepare and submit internal documentation through established review and approval processes, ensuring proper version control, file management, and coordination with SMEs and reviewers.
• Participate in operational model development activities by documenting process steps, creating visual workflows, and helping build initial drafts to be reviewed and finalized by the Senior Professional or Lead.
• Support the creation and maintenance of clinical auditing tools and other operational tools that will be used across markets, ensuring consistency and accessibility.
• Research and gather information from contracts, regulatory documents, and internal stakeholders to support the development of operational models.
• Track progress on document creation and submission tasks using internal project tracking systems (e.g., Smartsheet, OneNote, SharePoint), ensuring deadlines and deliverables are met.
• Participate in meetings and working sessions with cross-functional teams and take ownership of Care and Service Coordination-specific assignments. 
• Provide general project support to the cohort team and contribute to broader team efforts aimed at process improvement and operational readiness.
• Interpreting contract requirements and federal regulations for Medicare and Medicaid, including duals plans, and converting them into clear and understandable summaries or draft documentation for review by senior team members.
• Perform quality checks on documentation to ensure clarity, formatting, and alignment with submission standards.
• Take on stretch assignments or special projects to support business readiness and further develop expertise in Medicaid implementation and process improvement.

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s degree or 3 years of experience working in health plan operations
• 2+ years of experience in Care Management, including work with dually eligible Medicare–Medicaid members
• 2+ years of experience reviewing state Medicaid and federal Medicare contracts (SMAC, SOW, 1915(b), 1915(c)), or state/federal rules and regulations to identify care management requirements.
• Demonstrated passion for contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

• Licensed clinician (e.g., LSW, RN, etc.)
• Project management experience
• Experience with Medicare/Medicaid integrated models
• Experience working in cross‑functional settings
• Deep understanding of the Care Management Processes and how actions drive value for members and providers
• LTSS experience

Additional Information

• Schedule: Monday through Friday, 8:00 AM–5:00 PM, with flexibility to work overtime as needed
• Work Location: US — Nationwide
• Work Style: Remote
• Travel Requirements: Minimum (less than 10%)

Work-at-Home (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.
• 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 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.

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.

 

$78,400 - $107,800 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: 01-21-2026

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.

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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.