Remote Policy Governance Lead – Medicaid Compliance

Humana Inc; United States; Remote; USD 65,000 - 89,000; Full time

Job summary

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

You will coordinate schedules, validate data, and collaborate with operational and clinical stakeholders to drive improvements. The role involves preparing materials for UM Committees, maintaining audit-ready documentation, and supporting policy governance, accreditation, and compliance initiatives.

Qualifications

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

Attention to detail

Education

Bachelor's degree

Tools

Microsoft Excel

PowerPoint

Word

SharePoint

Job description

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

You will coordinate schedules, validate data, and collaborate with operational and clinical stakeholders to drive improvements. The role involves preparing materials for UM Committees, maintaining audit-ready documentation, and supporting policy governance, accreditation, and compliance initiatives.