Remote Vice President, Clinical Policy & Risk Management

Humana Inc; Denver (CO); Remote; USD 180,000 - 280,000; Full time

Job summary

Humana Inc. seeks a Vice President of Clinical Policy and Risk Management to lead a large team across CM/UM risk management, audits, and policy governance.

You will report to the Senior VP – Clinical Operations, shaping risk strategies that protect member care and regulatory compliance. In this remote role, you will partner with Legal, Compliance, and business leaders to interpret CMS and Medicaid rules, drive operational controls, and oversee business continuity while guiding a matrixed

Qualifications

• 10+ years in CM/UM risk management or regulatory compliance.
• 6+ years in leadership roles.
• Active clinical license and ability to apply clinical knowledge.
• Advanced knowledge of Medicare/ Medicaid regulations.
• Strong collaboration and executive presence.

Responsibilities

• Identify, assess, and report operational and clinical risks within CM/UM.
• Monitor compliance and metrics, escalate issues impacting member care or regulatory compliance.
• Track CMS and Medicaid regulations and ensure timely adoption.
• Support regulatory audits and remediation efforts.
• Lead risk mitigation and oversee CM/UM business continuity.
• Partner with Legal, Compliance, Regulatory Affairs on policy alignment.

Skills

CM/UM risk management

Regulatory compliance

Leadership

Executive communication

Project management

Internal controls

IT controls in CM/UM

Regulatory affairs liaison

Education

Bachelor’s degree

MBA preferred

Active clinical license

Job description

Humana Inc. seeks a Vice President of Clinical Policy and Risk Management to lead a large team across CM/UM risk management, audits, and policy governance.

You will report to the Senior VP – Clinical Operations, shaping risk strategies that protect member care and regulatory compliance. In this remote role, you will partner with Legal, Compliance, and business leaders to interpret CMS and Medicaid rules, drive operational controls, and oversee business continuity while guiding a matrixed