Policy Governance Professional

Become a part of our caring community The Policy Governance Professional supports the Medicaid Utilization Management Policy Governance program. Reporting to the Policy Governance Lead, the primary responsibility of this role is to manage the end-to-end Medicaid UM Rates and Timeliness evaluation and reporting process across applicable markets, including physical health and behavioral health. Responsibilities include coordinating reporting schedules and data validation with accountable teams, evaluating performance trends, investigating potential contributing factors with operational and clinical stakeholders, developing clear written evaluations and recommendations, coordinating physician leadership review and committee approval, and tracking follow-up actions and supporting documentation. The role supports coordination of other UM-related QIE elements as responsibilities are established. Job Responsibilities o Own and coordinate the end-to-end NCQA UM Rates and Timeliness Report process across applicable Medicaid markets and lines of business. o Manage reporting calendars, milestones, stakeholder responsibilities, data collection, validation, approvals, and final deliverables. o Partner with operational, analytical, clinical, quality, compliance, accreditation, and market teams to resolve data issues and report risks. o Analyze results to identify trends, outliers, performance concerns, and opportunities for improvement. o Coordinate, document, and monitor corrective or fol