Remote Policy Governance Analyst – Medicaid UM & Reporting

Humana Inc; Helena (MT); Remote; USD 65,000 - 89,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings

Paid time off

Remote work

Job summary

Humana Inc. is seeking a Policy Governance Professional to manage the end-to-end Medicaid UM Rates and Timeliness evaluation and reporting across applicable markets.

You will coordinate reporting calendars, validate data, and collaborate with clinical and operational stakeholders to generate clear evaluations and recommendations. The role supports other UM-related governance activities and requires a bachelor’s degree with healthcare operations or related experience.

Qualifications

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

Data governance

NCQA familiarity

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 across applicable markets.

You will coordinate reporting calendars, validate data, and collaborate with clinical and operational stakeholders to generate clear evaluations and recommendations. The role supports other UM-related governance activities and requires a bachelor’s degree with healthcare operations or related experience.