VP, Clinical Policy & Risk Management — Remote Leadership

Humana Inc; Lincoln (NE); Remote; USD 180,000 - 300,000; Full time

Job summary

Humana Inc. in Lincoln, Nebraska, seeks a Vice President of Clinical Policy and Risk Management to lead CM/UM risk management, audits, and policy governance. You will drive risk mitigation, regulatory alignment, and cross‑functional collaboration with Legal, Compliance, and business leaders.

Remote position with occasional travel; 40-hour weeks; 10+ years in CM/UM risk management and 6+ years in leadership; active clinical license preferred; MBA desired.

Qualifications

• Bachelor’s degree in a relevant field; MBA preferred.
• Active, unrestricted clinical license in applicable discipline.
• 10+ years in CM/UM risk management or regulatory compliance.
• 6+ years in leadership roles with stakeholder influence.
• Strong knowledge of CMS/Medicaid regulations and internal controls.
• Exceptional project management, integrity, and ethics.

Responsibilities

• Identify, assess, and report operational and clinical risks within CM/UM processes.
• Monitor CM/UM compliance and metrics; escalate and resolve issues.
• Track CMS Federal and Medicaid state regulations; ensure timely adoption.
• Support regulatory audits; facilitate remediation for CM/UM compliance.
• Lead risk mitigation and maturity assessments; oversee IOPs.
• Oversee CM/UM business continuity and cross‑leader resolution.
• Foster quality and continuous improvement within CM/UM controls.
• Address legislative and regulatory issues impacting CM/UM operations.

Skills

CM/UM Risk Management

Regulatory Compliance

Leadership

Executive Presence

Project Management

Internal Controls

IT Controls

Stakeholder Collaboration

CMS/Medicaid Regulations

Regulatory Audits

Education

Bachelor’s degree

MBA preferred

Job description

Humana Inc. in Lincoln, Nebraska, seeks a Vice President of Clinical Policy and Risk Management to lead CM/UM risk management, audits, and policy governance. You will drive risk mitigation, regulatory alignment, and cross‑functional collaboration with Legal, Compliance, and business leaders.

Remote position with occasional travel; 40-hour weeks; 10+ years in CM/UM risk management and 6+ years in leadership; active clinical license preferred; MBA desired.