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Humana

Policy Governance Professional

Humana

. Own and coordinate the end-to-end NCQA UM Rates and Timeliness Report process across applicable Medicaid markets and lines of business .

Posted 10/20/2026full-timeRemote • United StatesMid-LevelSenior💰 $65,000 - $88,600 per yearWebsite

Core Competencies

Role fit
Core Competencies

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Demonstrates expertise in managing end-to-end reporting processes within the healthcare industry, particularly in Medicaid markets. Proficient in data analysis, compliance, and governance activities, ensuring audit-ready documentation and effective stakeholder collaboration.

Highest-signal resume keywords
Healthcare Operations ExperienceUtilization Management ReportingNCQA Accreditation KnowledgeData Analysis and ValidationPolicy Governance Support

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills
Data AnalysisReporting ManagementCorrective Action CoordinationPerformance Improvement ActivitiesAudit Response Coordination
Soft Skills
Stakeholder CollaborationProblem-SolvingOrganizational Skills
Tools & Technologies
Microsoft ExcelMicrosoft PowerPointMicrosoft WordSharePointCollaboration Tools
Industry Keywords
Medicaid Managed CareAccreditation StandardsComplianceGovernance CommitteesRegulatory Requirements

About the role

Key responsibilities & impact
  • 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

What you’ll need
  • 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

Comp & perks
  • 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