Remote VP, Clinical Policy & Risk Management

Humana Inc; Montpelier (VT); Remote; USD 250,000 - 350,000; Full time

Benefits offered by this job

Remote work

Job summary

Humana Inc. seeks a Vice President of Clinical Policy and Risk Management to lead CM/UM risk management, audits, and policy governance. The role oversees a large team and partners with Legal, Compliance, and Regulatory Affairs to ensure adherence to federal and state laws.

The ideal candidate will bring an active clinical license and 10+ years in CM/UM risk management, with 6+ years in leadership, and a strong track record in regulatory compliance and executive communications.

Qualifications

• Active clinical license in the applicable discipline (e.g., RN, MD/DO, etc.).
• Extensive experience (10+ years) in CM/UM risk management, regulatory compliance, or related fields, with 6+ years in leadership.
• Strong knowledge of CMS/Medicaid/MIP regulatory requirements and internal controls.

Responsibilities

• Identify, assess, and report operational and clinical risks within CM/UM processes to governance structures.
• Monitor CM/UM compliance and metrics; escalate issues impacting member care or regulatory compliance.
• Interpret and implement CMS Federal and Medicaid State regulations affecting CM/UM.

Skills

Leadership

Regulatory compliance

Risk management

Project management

Executive presence

Cross-functional collaboration

Communication

Education

Bachelor's degree

MBA preferred

Active clinical license (RN/MD/etc)

Job description

Humana Inc. seeks a Vice President of Clinical Policy and Risk Management to lead CM/UM risk management, audits, and policy governance. The role oversees a large team and partners with Legal, Compliance, and Regulatory Affairs to ensure adherence to federal and state laws.

The ideal candidate will bring an active clinical license and 10+ years in CM/UM risk management, with 6+ years in leadership, and a strong track record in regulatory compliance and executive communications.