Policy Governance Lead
Humana
full-time
Posted on:
Location Type: Remote
Location: California • Illinois • United States
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Salary
💰 $115,200 - $158,400 per year
Job Level
About the role
- Oversee the development, review, and maintenance of Utilization Management (UM) policies and procedures, ensuring alignment with regulatory and enterprise standards.
- Support UM governance by collaborating with UM leadership and committees to ensure program operations meet internal and external requirements.
- Coordinate and manage the collection, analysis, and submission of quality reporting data relevant to UM, ensuring accuracy and timeliness.
- Serve as a resource for reporting and escalation of suspected policy violations, working in accordance with documented Humana procedures.
- Facilitate training and communication related to UM policy requirements, governance processes, quality reporting, and compliance protocols.
- Support audit activities, including maintaining records of policy lifecycle events, quality metrics, exceptions, and resolutions.
- Monitor regulatory and enterprise policy changes, translating requirements into updated UM governance and reporting practices.
Requirements
- Bachelor's degree
- 8 or more years of technical experience
- 2 or more years of project leadership experience
- Experience in utilization management, clinical operations, or health plan regulatory compliance
- Demonstrated knowledge of policy governance frameworks, regulatory standards, and privacy/security practices relevant to healthcare
- Proven ability to interpret and apply organizational policies and procedures
- Experience with quality reporting, data analysis, and program evaluation
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
Benefits
- Health benefits effective day 1
- Paid time off, holidays, volunteer time and jury duty pay
- Recognition pay
- 401(k) retirement savings plan with employer match
- Tuition assistance
- Scholarships for eligible dependents
- Parental and caregiver leave
- Employee charity matching program
- Network Resource Groups (NRGs)
- Career development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
data analysisquality reportingpolicy governance frameworksregulatory standardsprivacy practicessecurity practicesprogram evaluation
Soft skills
project leadershipcollaborationcommunicationtraining facilitationproblem-solving
Certifications
Bachelor's degree