Clinical Risk Management Lead

humana; United States; In loco; USD 110.000 - 150.000; Tempo pieno

Descrizione del lavoro

Humana seeks a Clinical Risk Management Lead to oversee risk activities across our Primary Care Organization, identifying, assessing, and mitigating risks in clinical practice, patient care, and operations. This role partners with clinical and business leaders to implement risk controls and improvements and reports to the Associate VP, Risk Management.

The position collaborates with CenterWell Senior Primary Care, Conviva, and MaxHealth, engaging Compliance, Legal, Privacy, HR, and Enterprise

Competenze

• Bachelor's degree or higher in Nursing, Physician Assistant Studies, or a related clinical discipline.
• Active and unrestricted clinical license.
• 5+ years of clinical healthcare experience.
• Experience collaborating with clinical leadership and interdisciplinary stakeholders.
• Strong analytical, communication, problem-solving, and risk assessment skills.
• Ability to evaluate clinical processes, identify risks, and recommend practical solutions.
• Experience presenting recommendations and findings to leadership audiences.

Mansioni

• Conduct clinical risk assessments to identify, evaluate, and prioritize risks in clinical operations.
• Develop and execute clinical risk management plans with control assessments and mitigation strategies.
• Partner with clinical leadership to implement effective controls and corrective actions.
• Present findings and risk mitigation recommendations to leadership and stakeholders.
• Collaborate with Compliance, Legal, Privacy, HR, and Safety teams on risk initiatives.
• Identify and resolve business issues related to clinical practice and operations.
• Guide partners through risk mitigation and corrective action planning.
• Conduct research and stakeholder interviews to support objective risk assessments.

Conoscenze

Risk assessment

Analytical

Communication

Leadership

Interdisciplinary collaboration

Formazione

Bachelor's degree or higher in Nursing/PA or related clinical field

Descrizione del lavoro

Become a part of our caring community

The Clinical Risk Management Lead supports clinical risk management activities across the Primary Care Organization (PCO) by identifying, assessing, monitoring, and mitigating risks related to clinical practice, patient care, regulatory compliance, and operational processes. This role partners with clinical and business leaders to evaluate risk exposure, assess existing controls, recommend improvements, and support the implementation of risk management strategies that align with organizational objectives. You will report to the Associate VP, Risk Management.

The position works closely with leaders across CenterWell Senior Primary Care, Conviva, and MaxHealth, as well as cross-functional partners in Compliance, Legal, Privacy, Human Resources, and Enterprise Health & Safety. The Clinical Risk Management Lead also serves as a clinical subject matter resource, providing guidance on clinical risk management, control design, issue mitigation, and regulatory considerations.

Key Responsibilities

• Conduct clinical risk assessments to identify, evaluate, and prioritize risks related to clinical operations, patient care, and healthcare delivery.
• Develop and execute clinical risk management plans, including assessment of existing controls and recommendations for risk mitigation strategies.
• Partner with clinical leadership to evaluate risks and support the implementation of effective controls and corrective actions.
• Present findings, recommendations, and risk mitigation strategies to leadership and key stakeholders.
• Collaborate with Compliance, Legal, Privacy, Human Resources, Enterprise Health & Safety, and other internal teams on risk-related initiatives.
• Identify, document, and support resolution of business issues related to clinical practice and operational processes.
• Guide business and clinical partners through risk mitigation and corrective action planning.
• Conduct research, gather information, interview stakeholders, and evaluate clinical risk scenarios to support objective risk assessments.
• Monitor emerging risks, trends, and regulatory requirements affecting primary care and value-based care operations.
• Support continuous improvement efforts related to risk management frameworks, controls, and clinical governance processes.

Required Qualifications

• Bachelor's degree or higher in Nursing, Physician Assistant Studies, or a related clinical discipline.
• Active and unrestricted clinical license.
• 5+ years of clinical healthcare experience.
• Experience collaborating with clinical leadership and interdisciplinary stakeholders.
• Strong analytical, communication, problem-solving, and risk assessment skills.
• Ability to evaluate clinical processes, identify risks, and recommend practical solutions.
• Experience presenting recommendations and findings to leadership audiences.

Preferred Qualifications

• Advanced Practice Registered Nurse (APRN) or Physician Assistant (PA) designation.
• 3+ years of experience in risk management, compliance, audit, healthcare quality, patient safety, clinical operations, or related fields.
• Experience within value-based care, population health, primary care, Medicare Advantage, or managed care environments.
• Knowledge of healthcare regulations, internal controls, clinical governance, and risk management frameworks.analysis<|message|>We lost track of string; we must output complete json. It's important to correctly escape entire string. The assistant truncated.We need to finish building string again in final.Let's recompose carefully and double-check quoting.We'll produce the string in one go, ensuring proper escaping and no truncation.We need to escape double quotes in