Remote VP, Clinical Policy & Risk Management

Humana Inc; Augusta (ME); Remote; USD 200,000 - 320,000; Full time

Job summary

Humana Inc. is seeking a strategic Vice President to lead Clinical Policy and Risk Management, overseeing 7 direct reports and 250 associates across CM/UM risk management, audits, and policy governance.

This executive will partner with Legal, Compliance, and business leaders to ensure regulatory alignment, robust risk mitigation, and continuous improvement to protect member care and enterprise outcomes. Remote work with occasional travel to Humana offices may be required; an active clinical

Qualifications

• Bachelor’s degree required; MBA preferred.
• Active, unrestricted clinical license in an applicable discipline.
• 10+ years in CM/UM risk management or regulatory compliance, with 6+ years in leadership.
• Advanced knowledge of CM/UM controls and Medicare/Medicaid requirements.
• Experience in internal controls, risk management, and IT controls.
• Excellent communication, integrity, and executive presence.

Responsibilities

• Identify, assess, and report operational and clinical risks within CM/UM.
• Monitor compliance metrics and escalate issues affecting member care or regulatory compliance.
• Interpret CMS Federal and Medicaid state regulations and drive adoption.
• Lead audits and remediation activities in CM/UM.
• Oversee business continuity and resolve IOPs with leadership.
• Foster continuous improvement and policy governance alignment.

Skills

Executive leadership

Risk management

Regulatory compliance

CMS/Medicaid knowledge

Internal controls

Project management

Executive presence

Cross-functional collaboration

Clinical license

Stakeholder influence

Education

Bachelor's degree

MBA preferred

Job description

Humana Inc. is seeking a strategic Vice President to lead Clinical Policy and Risk Management, overseeing 7 direct reports and 250 associates across CM/UM risk management, audits, and policy governance.

This executive will partner with Legal, Compliance, and business leaders to ensure regulatory alignment, robust risk mitigation, and continuous improvement to protect member care and enterprise outcomes. Remote work with occasional travel to Humana offices may be required; an active clinical