Remote Policy Governance Analyst - Medicaid UM & NCQA

Humana Inc; Carson City (NV); Remote; USD 65,000 - 89,000; Full time

Job summary

Humana Inc. is seeking a Policy Governance Professional to manage the end-to-end Medicaid UM Rates and Timeliness evaluation and reporting process across applicable markets, including coordination with operational and clinical stakeholders.

You will develop written evaluations, coordinate leadership review, and track follow-up actions and supporting documentation. The role supports other UM-related QIE elements and broader policy governance activities, with location listed as Remote US

Qualifications

• Bachelor’s degree required.
• Experience in healthcare operations, utilization management, quality, compliance, accreditation, reporting, governance, or related area.

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, 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, and audit-ready documentation supporting reporting results and decisions.
• Support broader Policy Governance activities, including committee operations, policy lifecycle processes, regulatory alignment, process documentation, and continuous improvement.

Skills

Data validation experience

Written evaluation skills

Healthcare industry awareness

Education

Bachelor’s degree

Tools

Microsoft Excel

PowerPoint

Word

SharePoint

Job description

Humana Inc. is seeking a Policy Governance Professional to manage the end-to-end Medicaid UM Rates and Timeliness evaluation and reporting process across applicable markets, including coordination with operational and clinical stakeholders.

You will develop written evaluations, coordinate leadership review, and track follow-up actions and supporting documentation. The role supports other UM-related QIE elements and broader policy governance activities, with location listed as Remote US