Humana · 1 day ago
Policy Governance Lead
United States
Full-time
Remote
Senior Level, Lead/Staff
$115K/yr - $158K/yr
8+ years expHumana Inc. is committed to putting health first and is seeking a Policy Governance Lead to oversee the development, implementation, and management of Utilization Management policies. This role involves collaborating with leadership to ensure compliance with regulatory requirements and facilitating effective communication of program changes and outcomes.
Health CareHealth InsuranceInsuranceVenture Capital
Responsibilities
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
Qualification
Required
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
Graduate or advanced degree
Background in policy or compliance
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
Medical, dental and vision benefits
Short-term and long-term disability
Life insurance
Company
Humana
Humana is a health insurance provider for individuals, families, and businesses.
10001+ employees
H1B Sponsorship
Humana has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (282)
2024 (246)
2023 (284)
2022 (274)
2021 (212)
2020 (84)
Funding
Current Stage
Public CompanyTotal Funding
$13.07B2025-05-30Post Ipo Debt· $5B
2025-03-03Post Ipo Debt· $1.25B
2024-03-11Post Ipo Debt· $2.25B
Leadership Team
Jim Rechtin
CEO and President
Colin Drylie
Senior Vice President, Experience Transformation
Recent News
2026-01-07
2026-01-06
2026-01-04
Company data provided by crunchbase