VP, Clinical Policy and Risk Management
New
H
HumanaHealthcare
United StatesFull-TimeVp
Salary not disclosed
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Job Details
- Experience
- 10+ years in CM/UM risk management, regulatory compliance, process improvement, or related fields, with 6 plus years in leadership roles.
- Required Skills
- Project Management
Requirements
- Bachelor's degree (MBA preferred).
- Active, unrestricted clinical license (e.g., RN, LCSW, LPC, LMFT, PharmD, MD/DO, or other relevant clinical credential).
- 10+ years experience in CM/UM risk management, regulatory compliance, or process improvement.
- 6+ years in leadership roles.
- Advanced knowledge of CM/UM operational controls and risk mitigation.
- Expertise in Medicare and Medicaid regulatory requirements.
- Experience with internal controls and IT technical controls within CM/UM.
- Exceptional project management skills.
- Strong ability to influence stakeholders in complex, matrixed environments.
- Excellent executive presence and communication skills.
- Home internet with at least 25 Mbps download and 10 Mbps upload speed.
- Access to a private, dedicated workspace.
Responsibilities
- Identify, assess, and report operational and clinical risks within CM/UM processes.
- Monitor CM/UM compliance and operational metrics to ensure resolution of issues impacting care or regulatory compliance.
- Interpret and implement CMS Federal and Medicaid State regulations affecting CM/UM.
- Lead risk mitigation efforts including maturity assessments and oversight of issues and opportunities.
- Oversee CM/UM business continuity and resolve identified operational issues.
- Foster quality and continuous improvement in control processes aligned with laws and standards.
- Collaborate with Legal, Compliance, and Regulatory Affairs to align policies and controls with federal and state laws.
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