Remote Medicaid Policy Governance Specialist

Humana; United States; Remote; USD 65.000 - 89.000; Vollzeit

Benefits dieser Stelle

Medical benefits

401(k) Plan

Paid time off & holidays

Disability insurance

Life insurance

Other opportunities

Zusammenfassung

Humana is seeking a Policy Governance Professional to support the Medicaid Utilization Management Policy Governance program. You will manage end-to-end Medicaid UM Rates and Timeliness evaluation across applicable markets, coordinating data validation, analyzing trends, and preparing written evaluations for leadership review.

Reporting to the Policy Governance Lead, you will collaborate with operational, clinical, quality, compliance and market teams to drive improvements and ensure audit-ready

Qualifikationen

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

Aufgaben

• Own and coordinate NCQA UM Rates and Timeliness reporting across Medicaid markets.
• Manage reporting calendars, milestones, data collection and approvals.
• Collaborate with operational, analytical, clinical, quality, compliance and market teams to resolve data issues.
• Analyze results to identify trends, outliers and improvement opportunities.
• Document and monitor corrective actions and follow-ups.
• Prepare summaries for Utilization Management Committees and leadership.
• Maintain audit-ready documentation supporting results, decisions and approvals.
• Support broader policy governance activities and continuous improvement.

Kenntnisse

Healthcare industry experience

Excel

PowerPoint

Word

SharePoint

Ausbildung

Bachelor’s degree

Tools

SharePoint

Jobbeschreibung

Humana is seeking a Policy Governance Professional to support the Medicaid Utilization Management Policy Governance program. You will manage end-to-end Medicaid UM Rates and Timeliness evaluation across applicable markets, coordinating data validation, analyzing trends, and preparing written evaluations for leadership review.

Reporting to the Policy Governance Lead, you will collaborate with operational, clinical, quality, compliance and market teams to drive improvements and ensure audit-ready