Remote Policy Governance Professional — Medicaid UM

Humana Inc; Dover (DE); Remote; USD 65,000 - 89,000; Full time

Benefits offered by this job

Bonus incentive plan

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 Medicaid markets, coordinating with diverse teams to ensure accuracy and timely delivery.

The role involves partnership with operational, analytical, clinical, quality, compliance, accreditation, and market teams, developing written evaluations, and supporting governance bodies. Remote US nationwide with periodic travel.

Qualifications

• Bachelor’s degree or higher in a related field.
• Experience in healthcare operations, utilization management, reporting, governance, or related areas.
• 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.

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 Medicaid markets, coordinating with diverse teams to ensure accuracy and timely delivery.

The role involves partnership with operational, analytical, clinical, quality, compliance, accreditation, and market teams, developing written evaluations, and supporting governance bodies. Remote US nationwide with periodic travel.