Medicaid Policy Governance Specialist — Remote

Humana Inc; Madison (WI); Remote; USD 65,000 - 89,000; Full time

Job summary

Humana Inc is seeking a Policy Governance Professional to oversee the end-to-end Medicaid Utilization Management (UM) Rates and Timeliness evaluation and reporting across markets, including collaboration with operational and clinical teams.

You will coordinate reporting schedules, validate data, identify trends, and develop written evaluations and recommendations for leadership and governance bodies. Remote US nationwide with potential travel for training.

Qualifications

• Bachelor’s degree required.
• Experience in healthcare operations, utilization management, governance, or reporting.
• Proficiency with MS Office (Excel, PowerPoint, Word) and SharePoint.

Responsibilities

• Own and coordinate the end-to-end NCQA UM Rates and Timeliness Report process across Medicaid markets.
• Manage reporting calendars, milestones, stakeholder responsibilities, data collection, validation, approvals.
• Partner with operations, analytics, 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 actions, escalating overdue or high-risk items.
• Prepare reporting summaries for Utilization Management Committees and governance bodies.
• Maintain audit-ready documentation supporting reporting results and approvals.
• Support broader policy governance activities and process improvement.

Skills

Healthcare experience

Excel

PowerPoint

Word

Collaboration tools

Education

Bachelor's degree

Tools

SharePoint

Job description

Humana Inc is seeking a Policy Governance Professional to oversee the end-to-end Medicaid Utilization Management (UM) Rates and Timeliness evaluation and reporting across markets, including collaboration with operational and clinical teams.

You will coordinate reporting schedules, validate data, identify trends, and develop written evaluations and recommendations for leadership and governance bodies. Remote US nationwide with potential travel for training.