Remote Medicaid Policy & Governance Specialist

Humana Inc; Trenton (NJ); Remote; USD 65,000 - 89,000; Full time

Job summary

Humana Inc. is seeking a Policy Governance Professional to manage end-to-end Medicaid Utilization Management (UM) Rates and Timeliness evaluation and reporting across markets.

Reporting to the Policy Governance Lead, you will coordinate data validation, analyze trends, and drive improvements with clinical and operational stakeholders. The role requires a bachelor’s degree, healthcare industry experience, and proficiency with Excel, PowerPoint, Word, and SharePoint.

Qualifications

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

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 operations, 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, and 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

Data reporting

Education

Bachelor’s degree

Tools

Excel

PowerPoint

Word

SharePoint

Job description

Humana Inc. is seeking a Policy Governance Professional to manage end-to-end Medicaid Utilization Management (UM) Rates and Timeliness evaluation and reporting across markets.

Reporting to the Policy Governance Lead, you will coordinate data validation, analyze trends, and drive improvements with clinical and operational stakeholders. The role requires a bachelor’s degree, healthcare industry experience, and proficiency with Excel, PowerPoint, Word, and SharePoint.