Policy Governance Professional
成为我们关心社区的一部分政策治理专业支持医疗补助利用管理政策治理计划。向政策治理领导报告，该角色的主要责任是管理适用的市场中终端医疗补救 UM 率和及时评估和报告过程，包括身体健康和行为健康。负责人包括与负责任团队协调报告时间表和数据验证，评估绩效趋势，与运营和临床利益相关者调查潜在贡献因素，制定明确的书面评价和建议，协调医生领导审查和委员会批准，跟踪后续行动和支持文件。该角色支持建立其他有关 MEDQE 要素的协调。工作职责 o 拥有并协调适用的 MEDcaid 市场和业务领域内的全端 NCQA UM 率和及时性报告过程。管理报告日历，里程碑，利益相关者责任，数据收集，验证，批准和最终成果。o 与运营，分析，临床，质量，合规，认可和市场团队合作解决数据问题并报告风险。o 分析结果以确定趋势，异常值，绩效担忧以及改善机会。o 协调，记录和监测纠正或后续行动，根据情况加剧过期或高风险项目。o 准备报告总结和材料由利用管理委员会，领导层和其他治理机构审查。支持更广泛的政策治理活动，包括委员会运作，政策生命周期流程，监管协调，过程文件和持续改进。该角色还支持相关的政策治愈，认可，合规和进程改善活动。使用你的技能产生影响所需资格 o 学士学位 o 医疗保健行业经验 （运营，利用管理，质量，合规，认证，报告，治理或相关领域）. o 熟练使用微软 Excel,PowerPoint,Word,SharePoint 以及相关的协作或跟踪工具。优先资格
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Become a part of our caring community
The Policy Governance Professional supports the Medicaid Utilization Management Policy Governance program. Reporting to the Policy Governance Lead, the primary responsibility of this role is to manage the end-to-end Medicaid UM Rates and Timeliness evaluation and reporting process across applicable markets, including physical health and behavioral health. Responsibilities include coordinating reporting schedules and data validation with accountable teams, evaluating performance trends, investigating potential contributing factors with operational and clinical stakeholders, developing clear written evaluations and recommendations, coordinating physician leadership review and committee approval, and tracking follow-up actions and supporting documentation. The role supports coordination of other UM-related QIE elements as responsibilities are established.Job Responsibilities
o Own and coordinate the end-to-end NCQA UM Rates and Timeliness Report process across applicable Medicaid markets and lines of business.
o Manage reporting calendars, milestones, stakeholder responsibilities, data collection, validation, approvals, and final deliverables.
o Partner with operational, analytical, clinical, quality, compliance, accreditation, and market teams to resolve data issues and report risks.
o Analyze results to identify trends, outliers, performance concerns, and opportunities for improvement.
o Coordinate, document, and monitor corrective or follow-up actions, escalating overdue or high-risk items as appropriate.
o Prepare reporting summaries and materials for review by Utilization Management Committees, leadership, and other governance bodies.
o Maintain complete, organized, and audit-ready documentation supporting reporting results, decisions, approvals, and committee oversight.
o Support broader Policy Governance activities, including committee operations, policy lifecycle processes, regulatory alignment, process documentation, and continuous improvement.
o The role also supports related policy governance, accreditation, compliance, and process-improvement activities.
Use your skills to make an impact
Required Qualifications
o Bachelor’s degree
o Experience in healthcare industry (operations, utilization management, quality, compliance, accreditation, reporting, governance, or a related area.)
o Proficiency with Microsoft Excel, PowerPoint, Word, SharePoint, and related collaboration or tracking tools.
Preferred Qualifications
o Experience supporting Medicaid managed care or another government-sponsored healthcare program.
o Knowledge of NCQA accreditation standards and experience supporting accreditation survey preparation.
o Experience supporting governance committees or other formal oversight bodies.
o Experience interpreting regulatory, contractual, accreditation, or policy requirements.
o Experience coordinating corrective actions, performance improvement activities, or audit responses.
o Familiarity with data validation, reporting controls, and centralized national/state policy governance models.
Additional Information
Location: Remote US Nationwide
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Interview Format
As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$65,000 - $88,600 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 10-26-2026
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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