Process Improvement Lead

Job Summary

The Process Improvement Lead analyzes and measures the effectiveness of existing business processes and develops sustainable, repeatable and quantifiable business process improvements. The Process Improvement Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

Key Accountabilities

• 20% Maintain current knowledge of the TRICARE program through involvement in day-to-day UM activities and discussions with UM leaders.
• 20% Review and monitor Contract Change Orders and evaluate impact on Utilization Management processes. Organize and facilitate Change Order workgroup and maintain documentation for implementation task completion.
• 15% Collaborate with UM leaders and clinicians to identify opportunities to implement electronic prior authorization technology, implement software rules to deploy the technology, and communicate with leaders throughout the process.
• 15% Collaborate with UM leaders to develop process mapping for operational processes and offer recommendations for optimization and/or improvements.
• 15% Assist with research, development and submission of quarterly evolving practices report in collaboration with other UM associates and Medical Directors.
• 10% Create and maintain department communications in the form of monthly/quarterly newsletters, SharePoint site maintenance and support, or other forms of team communications as needed.
• 5% Other duties as identified by UM leaders that support and optimize operational processes, which may include assisting with policies & procedures, UM reaccreditation readiness, system testing.

Process Improvement Lead Role

• Detail-oriented individuals are essential when streamlining and perfecting the operating models of a successful company.
• The Process Improvement Lead contributes to the success of Humana's business strategy by continuously reevaluating existing work processes in order to predict, address and resolve issues of noncompliance while delivering Humana's trademark innovative products and services to consumers.

Skills and Responsibilities

• 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.
• Advise 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.

Business Acumen

• Understands how one’s role and team add value for customers.
• Understands how the various parts of Humana work together to turn our strategy into reality and ultimately make Humana competitive in the marketplace.
• Acts in accordance with Humana's ethics and compliance policies and connects industry and regulatory changes to our strategy.
• Articulates how Humana's value proposition differentiates us.

Company Policies & Procedures

• Is knowledgeable of the internal and external regulations that influence the company's position and established policies.
• Applies that knowledge to assessing, developing, and/or infusing policies and procedures with business operations.

Compliance

• Understands the federal and state regulatory environment in relation to insurance and business practices.
• Understands the requirements for developing, implementing and enforcing compliance.