Senior Process Improvement Professional, Care and Service Coordination Strategy

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, One Note, 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.
• Interpret contract requirements and federal regulations for Medicare and Medicaid, including duals plans, and convert 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.

• 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…