Policy Governance Professional

This position is listed on behalf of a partner company, which manages all applications and next steps. Our partner is looking for a Policy Governance Professional based in the United States. As a Policy Governance Professional, you will play a key role in strengthening policy oversight, regulatory compliance, and quality management across Medicaid utilization management programs. You will coordinate end-to-end reporting processes, ensuring accurate data, timely deliverables, and reliable documentation across multiple markets and healthcare service areas. Working closely with clinical, operational, analytical, and compliance teams, you will identify performance trends, investigate potential issues, and recommend actionable improvements. You will also support governance committees, accreditation activities, and corrective action tracking to promote accountability and continuous improvement. This role offers the opportunity to contribute to high-quality healthcare operations within a collaborative, multidisciplinary environment. Designed for a detail-oriented professional with strong analytical and organizational skills, this is a full-time remote opportunity with nationwide availability across the United States.

Medicaid Utilization Management Reporting: Own and coordinate the end-to-end National Committee for Quality Assurance (NCQA) Utilization Management (UM) Rates and Timeliness reporting process across applicable Medicaid markets and lines of business, including physical and behavioral health. Reporting Coordination & Delivery: Manage reporting calendars, milestones, stakeholder responsibilities, data collection, validation, approval workflows, and final deliverables to ensure accurate and timely submissions. Cross-Functional Collaboration: Partner with operational, clinical, analytical, quality, compliance, accreditation, and market teams to resolve data discrepancies, address reporting risks, and maintain alignment across stakeholders. Performance Analysis & Evaluation: Review reporting results to identify trends, outliers, performance concerns, and opportunities for improvement. Investigate contributing factors with relevant operational and clinical stakeholders. Corrective Action Management: Coordinate, document, and monitor corrective actions and follow-up activities, escalating overdue items and high-risk issues to the appropriate stakeholders. Governance Committee Support: Prepare clear reporting summaries, evaluation findings, recommendations, and presentation materials for Utilization Management Committees, leadership teams, and other governance bodies. Documentation & Audit Readiness: Maintain complete, accurate, and organized records supporting reporting outcomes, data validation, decisions, approvals, committee reviews, and follow-up activities. Policy Governance & Lifecycle Management: Support policy governance processes, including committee operations, policy lifecycle activities, process documentation, regulatory alignment, and the continuous improvement of governance practices. Accreditation & Compliance Support: Contribute to related accreditation, compliance, and quality improvement activities, helping ensure alignment with applicable regulatory, contractual, and policy requirements. Continuous Improvement: Identify opportunities to strengthen reporting controls, streamline workflows, improve accountability, and enhance the effectiveness of policy governance processes across markets. Requirements Education: Bachelor's degree in any relevant discipline. Healthcare Industry Experience: Professional experience in healthcare operations, utilization management, quality assurance, compliance, accreditation, reporting, governance, or a related field. Technical Proficiency: Strong working knowledge of Microsoft Excel, PowerPoint, Word, SharePoint, and related collaboration, documentation, and tracking tools. Reporting & Data Validation: Ability to coordinate reporting activities, validate data, identify inconsistencies, interpret performance results, and maintain accurate supporting documentation. Analytical & Problem-Solving Skills: Strong analytical judgment and attention to detail, with the ability to investigate performance trends, identify contributing factors, and develop practical recommendations. Project & Process Coordination: Excellent organizational and time-management skills, including the ability to manage reporting calendars, coordinate multiple stakeholders, track deliverables, and meet deadlines. Communication & Stakeholder Management: Strong written and verbal communication skills, with the ability to prepare clear reports, present findings, coordinate committee reviews, and work effectively with clinical, operational, and leadership teams. Medicaid & Government Healthcare Knowledge: Experience supporting Medicaid managed care or other government-sponsored healthcare programs is preferred. Accreditation & Regulatory Knowledge: Familiarity with NCQA accreditation standards, accreditation survey preparation, and the interpretation of regulatory, contractual, accreditation, or policy requirements is an advantage. Governance Experience: Previous experience supporting formal governance committees, oversight bodies, policy management processes, or centralized national and state policy governance models is preferred. Corrective Action & Quality Improvement: Experience coordinating corrective action plans, performance improvement initiatives, audit responses, or related compliance activities is desirable. Remote Work Readiness: Ability to work independently in a remote environment, maintain a dedicated workspace that protects confidential member information in accordance with HIPAA requirements, and access a reliable internet connection with minimum speeds of 25 Mbps download and 10 Mbps upload. Additional Conditions: Occasional travel to company offices for training or meetings may be required. The recruitment process may include technology-assisted interviews through a third-party platform. Benefits Competitive Annual Salary: Estimated base salary ranging from $65,000 to $88,600 , depending on geographic location, relevant experience, qualifications, skills, and education. Performance-Based Bonus: Eligibility for a bonus incentive plan based on individual and/or organizational performance. Comprehensive Healthcare Coverage: Medical, dental, and vision benefits designed to support employees and their families. Retirement Savings: Access to a 401(k) retirement savings plan. Paid Time Off: Paid time off, company holidays, and personal holidays to support work-life balance. Family-Friendly Leave: Paid parental and caregiver leave. Financial Protection: Short-term disability, long-term disability, and life insurance coverage. Remote Work Flexibility: Nationwide remote work arrangement, offering flexibility and eliminating the need for daily office attendance. Professional Development: Opportunities to strengthen expertise in healthcare policy governance, Medicaid utilization management, regulatory compliance, accreditation, and quality improvement. Collaborative Work Environment: Work alongside multidisciplinary teams and contribute to initiatives that support operational excellence and healthcare quality. Full-Time Schedule: Standard working schedule of 40 hours per week. Application Deadline: October 26, 2026.