Policy Governance Lead

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The Policy Governance Lead is the combination of Compliance processes established and executed that are reflected in the organization's structure and how it is managed and led toward achieving goals. The Policy Governance Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

The Policy Governance Lead for Utilization Management (UM) is responsible for overseeing the development, implementation, and management of UM policies and related quality reporting activities. Additionally, this role supports Utilization Management (UM) governance by collaborating with UM leadership and committees to ensure that UM program operations align with regulatory requirements, internal standards, and continuous improvement objectives. The Lead coordinates with relevant stakeholders to facilitate policy review, compliance monitoring, quality reporting, and effective communication of program changes and outcomes.

Responsibilities include:

• 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.

• 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

• Graduate or advanced degree
• Background in policy or compliance

WAH Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
• Satellite, cellular and microwave connection can be used only if approved by leadership.
• Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

• 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

As part of our hiring process for this opportunity, we will be using an interviewing technology called Hire Vue to enhance our hiring and decision-making ability. Hire Vue allows us to quickly connect and…