[Hiring] Policy Governance Professional @Humana

Role Description

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.

• 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.

Qualifications

• Bachelor’s degree
• 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.

Requirements

• Experience supporting Medicaid managed care or another government-sponsored healthcare program.
• Knowledge of NCQA accreditation standards and experience supporting accreditation survey preparation.
• Experience supporting governance committees or other formal oversight bodies.
• Experience interpreting regulatory, contractual, accreditation, or policy requirements.
• Experience coordinating corrective actions, performance improvement activities, or audit responses.
• Familiarity with data validation, reporting controls, and centralized national/state policy governance models.

Benefits

• 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
• Many other opportunities

Company Description

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.