Chief of Clinical Policy & Risk Management

Humana Inc; Austin (TX); Remote; USD 180,000 - 280,000; Full time

Job summary

Humana Inc. seeks a Vice President of Clinical Policy and Risk Management to oversee a large team across CM/UM risk management, audits, and policy governance. The role reports to the Senior VP of Clinical Operations and drives regulatory compliance, quality, and risk mitigation.

Ideal candidates will hold an active clinical license, have 10+ years in CM/UM risk, and at least 6 years in leadership, with strong communication and executive presence to influence across a complex enterprise.

Qualifications

• Bachelor’s degree in a clinical field or related discipline.
• Active, unrestricted clinical license (RN/LCSW/LPC/LMFT/PharmD/MD/DO or equivalent).
• 10+ years CM/UM risk management or regulatory compliance experience.
• 6+ years in leadership roles within CM/UM environments.
• Strong knowledge of Medicare/Medicaid regulatory requirements.
• Proven ability to lead complex risk mitigation programs.
• Excellent communication and executive presence.
• Ability to influence across a matrixed organization.

Responsibilities

• Identify, assess, and report operational and clinical risks within CM/UM processes.
• Monitor CM/UM compliance and metrics, escalating issues as needed.
• Track CMS regulations and ensure timely adoption.
• Support audits and remediation efforts for CM/UM.
• Lead risk mitigation and maturity assessments for CM/UM.
• Oversee business continuity and address IOPs with leadership.
• Foster quality and continuous improvement in CM/UM controls.
• Collaborate with Legal, Compliance, Regulatory Affairs, and business leaders.

Skills

Clinical risk mgmt

Regulatory compliance

Project management

IT controls

Leadership

Executive presence

Stakeholder collaboration

Communication skills

Education

Bachelor’s degree

MBA preferred

Job description

Humana Inc. seeks a Vice President of Clinical Policy and Risk Management to oversee a large team across CM/UM risk management, audits, and policy governance. The role reports to the Senior VP of Clinical Operations and drives regulatory compliance, quality, and risk mitigation.

Ideal candidates will hold an active clinical license, have 10+ years in CM/UM risk, and at least 6 years in leadership, with strong communication and executive presence to influence across a complex enterprise.