Policy Governance Professional

This is a fully remote position, open to applicants in United States.

📋 Description

• Take ownership and manage the complete NCQA UM Rates and Timeliness Report process across relevant Medicaid markets and business lines.

• Oversee reporting schedules, significant milestones, stakeholder responsibilities, data gathering, validation, approvals, and final outputs.

• Collaborate with operational, analytical, clinical, quality, compliance, accreditation, and market teams to address data challenges and reporting risks.

• Evaluate results to pinpoint trends, anomalies, performance issues, and areas for enhancement.

• Organize, document, and track corrective or follow-up initiatives, escalating overdue or high-risk items as necessary.

• Create reporting summaries and materials for Utilization Management Committees, leadership, and other governance entities.

• Ensure comprehensive, organized, and audit-ready documentation that supports reporting outcomes, decisions, approvals, and committee oversight.

• Assist with broader Policy Governance activities, including committee operations, policy lifecycle processes, regulatory alignment, process documentation, and ongoing improvement.

• Aid in related policy governance, accreditation, compliance, and process enhancement tasks.

• Report directly to the Policy Governance Lead.

⛳️ Requirements

• A Bachelor’s degree is required.

• Experience in the healthcare sector, encompassing operations, utilization management, quality, compliance, accreditation, reporting, governance, or a related field.

• Expertise in Microsoft Excel, PowerPoint, Word, SharePoint, and associated collaboration or tracking tools.

• Capability to work remotely from anywhere in the United States.

• Home internet connection with a minimum of 25 Mbps download and 10 Mbps upload speeds.

• A dedicated workspace free from interruptions to protect member PHI/HIPAA information.

• Preferred: Experience in supporting Medicaid managed care or another government-sponsored healthcare initiative.

• Preferred: Familiarity with NCQA accreditation standards and experience in preparing for accreditation surveys.

• Preferred: Experience in supporting governance committees or formal oversight bodies.

• Preferred: Experience in interpreting regulatory, contractual, accreditation, or policy mandates.

• Preferred: Background in coordinating corrective actions, performance improvement initiatives, or audit responses.

• Preferred: Knowledge of data validation, reporting controls, and centralized national/state policy governance frameworks.

🏝️ 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 specific space requirements and internet service support criteria.