Remote Policy Governance Specialist (Medicaid UM)

Humana Inc; Denver (CO); Remote; USD 65,000 - 89,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Job summary

Humana Inc. is seeking a Policy Governance Professional to support Medicaid Utilization Management policy governance, including rates and timeliness evaluation and reporting. You will coordinate schedules, validate data, and drive improvements with clinical and operational partners.

The role involves governance coordination across markets, preparation of committee materials, and maintaining audit-ready documentation. Remote US nationwide with travel as needed.

Qualifications

• Bachelor’s degree required.
• 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.

Skills

Bachelor’s degree

Healthcare operations

MS Office proficiency

Education

Bachelor’s degree

Tools

Microsoft Excel

PowerPoint

Word

SharePoint

Job description

Humana Inc. is seeking a Policy Governance Professional to support Medicaid Utilization Management policy governance, including rates and timeliness evaluation and reporting. You will coordinate schedules, validate data, and drive improvements with clinical and operational partners.

The role involves governance coordination across markets, preparation of committee materials, and maintaining audit-ready documentation. Remote US nationwide with travel as needed.