Policy Governance Professional

Humana

2d•$65,000 - $88,600•Remote

About The Position

The Policy Governance Professional supports Humana’s Medicaid Utilization Management Policy Governance program. Reporting to the Policy Governance Lead, this role manages the end-to-end Medicaid UM Rates and Timeliness evaluation and reporting process across applicable markets, including physical and behavioral health. The position coordinates reporting schedules and data validation, evaluates performance trends, investigates potential contributing factors with operational and clinical stakeholders, develops written evaluations and recommendations, coordinates physician leadership review and committee approval, and tracks follow-up actions and supporting documentation. The role may also support coordination of other UM-related QIE elements as responsibilities are established, along with related policy governance, accreditation, compliance, and process-improvement activities. This is a remote U.S. position. Occasional travel to Humana offices for training or meetings may be required. The role is scheduled for 40 hours per week. Home-based employees must have internet service with at least 25 Mbps download and 10 Mbps upload speeds and work from a dedicated space that protects member PHI/HIPAA information. The position is eligible for a bonus incentive plan. Humana offers medical, dental, and vision benefits; a 401(k) retirement savings plan; paid time off and holidays; paid parental and caregiver leave; short- and long-term disability; life insurance; and other benefits.

Requirements

Bachelor’s degree.
Experience in the healthcare industry in operations, utilization management, quality, compliance, accreditation, reporting, governance, or a related area.
Proficiency with Microsoft Excel, PowerPoint, Word, SharePoint, and related collaboration or tracking tools.

Nice To Haves

Experience supporting Medicaid managed care or another government-sponsored healthcare program.
Knowledge of NCQA accreditation standards and experience supporting accreditation survey preparation.
Experience supporting governance committees or other formal oversight bodies.
Experience interpreting regulatory, contractual, accreditation, or policy requirements.
Experience coordinating corrective actions, performance improvement activities, or audit responses.
Familiarity with data validation, reporting controls, and centralized national/state policy governance models.

Responsibilities

Own and coordinate the end-to-end NCQA UM Rates and Timeliness Report process across applicable Medicaid markets and lines of business.
Manage reporting calendars, milestones, stakeholder responsibilities, data collection, validation, approvals, and final deliverables.
Partner with operational, analytical, clinical, quality, compliance, accreditation, and market teams to resolve data issues and report risks.
Analyze results to identify trends, outliers, performance concerns, and opportunities for improvement.
Coordinate, document, and monitor corrective or follow-up actions, escalating overdue or high-risk items as appropriate.
Prepare reporting summaries and materials for review by Utilization Management Committees, leadership, and other governance bodies.
Maintain complete, organized, audit-ready documentation supporting reporting results, decisions, approvals, and committee oversight.
Support broader Policy Governance activities, including committee operations, policy lifecycle processes, regulatory alignment, process documentation, and continuous improvement.
Support related policy governance, accreditation, compliance, and process-improvement activities.
Support coordination of other UM-related QIE elements as responsibilities are established.