Remote Policy Governance Specialist – Medicaid UM

Humana Inc; Montpelier (VT); 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 manage end‑to‑end Medicaid UM Rates and Timeliness reporting across applicable markets, including coordination with clinical, operational, and governance teams.

The role emphasizes documentation, compliance, and continuous improvement within a remote US nationwide setting. You will collaborate with multiple stakeholders, schedule reporting, validate data, and support committee oversight while ensuring audit‑ready records and alignment

Qualifications

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

Responsibilities

• Own and coordinate the NCQA UM Rates and Timeliness reporting across Medicaid markets.
• Manage reporting calendars, milestones, data collection, validation, and approvals.
• Collaborate with operations, analytics, clinical, quality, compliance and market teams to resolve data issues and report risks.
• Analyze results to identify trends, performance concerns and opportunities for improvement.
• Prepare summaries and materials for Utilization Management Committees and leadership.

Education

Bachelor’s degree

Tools

Excel

PowerPoint

Word

SharePoint

Job description

Humana Inc. is seeking a Policy Governance Professional to manage end‑to‑end Medicaid UM Rates and Timeliness reporting across applicable markets, including coordination with clinical, operational, and governance teams.

The role emphasizes documentation, compliance, and continuous improvement within a remote US nationwide setting. You will collaborate with multiple stakeholders, schedule reporting, validate data, and support committee oversight while ensuring audit‑ready records and alignment