Medicaid UM Policy Governance Specialist

Humana Inc; Phoenix (AZ); Remote; USD 65,000 - 89,000; Full time

Benefits offered by this job

Bonus incentive plan

Job summary

Humana Inc. is seeking a Policy Governance Professional to manage the Medicaid UM Rates and Timeliness evaluation and reporting process across markets, collaborating with cross-functional teams to ensure accuracy and compliance.

The role supports policy governance, accreditation, and continuous improvement initiatives, with a strong emphasis on data validation and documentation. Location is remote in the US nationwide.

Qualifications

• Experience in healthcare operations, utilization management, quality, compliance, reporting, governance, or related areas.
• Proficiency with Microsoft Excel, PowerPoint, Word, SharePoint, and related collaboration/tracking tools.

Responsibilities

• Own and coordinate the end-to-end NCQA UM Rates and Timeliness Report process across 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 UM 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.
• The role also supports related policy governance, accreditation, compliance, and process-improvement activities.

Skills

Healthcare industry experience

Education

Bachelor's degree

Tools

Microsoft Excel

PowerPoint

Word

SharePoint

Job description

Humana Inc. is seeking a Policy Governance Professional to manage the Medicaid UM Rates and Timeliness evaluation and reporting process across markets, collaborating with cross-functional teams to ensure accuracy and compliance.

The role supports policy governance, accreditation, and continuous improvement initiatives, with a strong emphasis on data validation and documentation. Location is remote in the US nationwide.