Policy Governance Lead

Become a part of our caring community and help us put health first

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.

Use your skills to make an impact

Required Qualifications

• 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

Preferred Qualifications

• Graduate or advanced degree

• Background in policy or compliance

Additional Information

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.

Benefits

Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:

• 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

HireVue

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

SSN Alert

Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from [email protected] with instructions on how to add the information into your official application on Humana's secure website.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$115,200 - $158,400 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 01-14-2026

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and 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. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our