Policy Governance Professional

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $65k - $88.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🎲 Risk

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👻 Ghost score 0%

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• 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 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 • Support related policy governance, accreditation, compliance, and process-improvement activities • Report to the Policy Governance Lead

🎯 Requirements

• Bachelor’s degree • Experience in the healthcare industry, including 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 • Ability to work remotely from the United States nationwide • Home internet with at least 25 Mbps download and 10 Mbps upload speeds • Dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information • Preferred: Experience supporting Medicaid managed care or another government-sponsored healthcare program • Preferred: Knowledge of NCQA accreditation standards and experience supporting accreditation survey preparation • Preferred: Experience supporting governance committees or formal oversight bodies • Preferred: Experience interpreting regulatory, contractual, accreditation, or policy requirements • Preferred: Experience coordinating corrective actions, performance improvement activities, or audit responses • Preferred: Familiarity with data validation, reporting controls, and centralized national/state policy governance models

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Remote work arrangement • Occasional travel to Humana offices for training or meetings • Home office work with dedicated space requirements and internet service support criteria