Vice President, Clinical Policy & Risk Management
Confidential
Vice President, Clinical Policy & Risk Management
About the Company
Influential organization in the health & wellness industry
Industry
Insurance
Type
Public Company
Founded
1964
Employees
10,001+
Categories
- Business Services
- Insurance
- Health and Wellness
- Health
- Health Care
- Hospitals
- Kentucky
- Life and Health
- Managed Care
- Health Insurance
- Louisville
- Venture Capital
- Health & Wellness
- Finance
Business Classifications
- B2C
About the Role
The Company is seeking a Vice President for Clinical Policy and Risk Management to lead a large department dedicated to ensuring the safety and compliance of care and utilization management processes. The successful candidate will be responsible for a wide range of activities, including the identification, assessment, and reporting of operational and clinical risks, as well as the monitoring of compliance and operational metrics. This role requires a strategic leader who can drive risk mitigation efforts, support regulatory audits, and foster a culture of quality and continuous improvement. The Vice President will also be expected to address legislative and regulatory issues, particularly those related to fraud risk, and to partner with various stakeholders to ensure that the company's policies and practices align with federal and state laws. Key qualifications for this role at the company include a Bachelor's degree (MBA preferred), an active clinical license, and over 10 years of experience in CM/UM risk management, regulatory compliance, or related fields, with at least 6 years in leadership positions. The ideal candidate will have advanced knowledge of CM/UM operational controls, risk mitigation strategies, and regulatory requirements for Medicare and Medicaid. They should be adept at internal controls, clinical and operational risk management, and IT technical controls within CM/UM environments. Exceptional project management skills, integrity, and the ability to influence outcomes in complex, matrixed environments are essential. The role demands an individual with excellent communication skills, executive presence, and the ability to collaborate with stakeholders across the enterprise.
Hiring Manager Title
Senior Vice President – Clinical Operations
Functions
- Medical Care/Hospital Administration
- Operations
- ...JOB SUMMARY The Vice President of Compliance serves as... ...compliance program across clinical, operational,... ...organizational compliance risks, including regulatory... ...privacy coordination, policy governance, audit readiness... .... • Audit, Risk Management & Corrective Action...PolicyContract work
MENTAL HEALTH SYSTEMS INC
San Diego, CA18 days ago $275k - $320k
...-enabling activities through clinical proof of concept. The PTL... ...commercialization, and lifecycle management. Adapt strategy as the... ...execution plans. Lead program risk management, scenario planning... ..., or local laws. Privacy Policy: The protection of your...PolicyLocal area- ...Vice President of Finance & Administration About the Company Nationally... ...Non-Profit Organization Management Type Non Profit... ...strategy, internal controls, and risk management are in line with... ...implementation of financial policies and procedures, as well as oversee...Policy
- ...Vice President, Risk & Insurance About the Company Nationally recognized commercial construction... ...operations teams on the evaluation, management, and mitigation of operational and... ...be responsible for developing scalable policies and processes that enhance risk visibility...Policy
$172.68k - $268.35k
...898-9313 or email: Assumes full management responsibility for Financial Services Department... ...payroll, budget preparation, auditing, risk management, audit compliance, and... ...the implementation of goals, objectives, policies, procedures, and work standards for the...PolicyFull timeContract workFor contractorsWork at officeLocal areaSan Diego Housing Commission
San Diego, CA2 days ago$325k - $350k
...are provided. Job Summary The Vice President and General Manager serves as the property’s executive leader... ...Ensure compliance with all company policies and applicable laws while... ...guests and associates through effective risk management and operational oversight...PolicyLocal areaFlexible hoursNight shift- ...Vice President, Risk & Underwriting Manager, Payments About the Company Fast-paced payments business strengthening risk, compliance, and governance... ...This role requires the development and maintenance of policies, procedures, and risk frameworks, as well as...Policy
$307.19k - $372.24k
...Reporting directly to the President of RayzeBio, the Vice President, Data, Analytics... ...translational science through clinical development and CMC.... ...time off (unlimited, with manager approval, 11 paid national... ...with applicable data privacy policies and regulations. If you...PolicyHourly payFull timeTemporary workPart timeFor contractorsSummer workLive inWork at officeLocal areaRemote workFlexible hoursShift workBristol-Myers Squibb
San Diego, CA21 hours ago$128.75k - $214.65k
...invites you to apply today.Job Overview:The Vice President, People Integration Partner is... ...transactions are integrated effectively, risks are managed, and employees are successfully... ...regulatory requirements, and company policies.LeadershipLead cross-functional teams...PolicyFull timeWork from homeLPL Financial
San Diego, CA4 days ago- ...Vice President, Medical Affairs Global Engagement Strategy About the... ...individual with an advanced clinical or scientific degree, a minimum... ...KOL Working Group, and managing KOL engagement programming.... ...relevant regulations and company policies. Hiring Manager Title...Policy
$236.96k - $259k
...motivated and organized candidate for the Vice President, Asset Management position. The successful candidate... ...compliance, contract management, and risk management across the energy... ...and stakeholder engagement. Monitor policy developments, market dynamics, and emerging...PolicyFull timeContract workLocal areaFlexible hoursNight shift$259k - $363k
...culture thrive. Join us as a Vice President, Business Development, and you... ...development decisions Manage and maintain business development... ...including Commercial, Legal, R&D, Clinical, Regulatory, Manufacturing,... ...(EEO) employer. It is the policy of the Company to provide equal...PolicyContract work$305k - $412k
Department:106750 Clinical DevelopmentLocation:San Diego, USA- RemoteBe... ....Position Summary:The Vice President, Clinical Development (Nephrology... ..., plans, issues and risks with team members, department... ...multi-task, prioritize, and manage shifting responsibilities in...Full timeTemporary workRemote workShift workTravere Therapeutics
San Diego, CAa month ago$295.4k
...do more and become more than you ever thought possible.The Vice President of Clinical Solutions Product Development will lead the end-to-end‑... ...strategy.Partners with R&D groups, Medical Affairs, and Product Management on future strategy and clinical needs in developing...Full timeLocal areaIllumina
San Diego, CAa month ago- ...Vice President, Clinical Development & Operations About the Company Vibrant data transformation company specializing in commercialization... ...development and revenue generation. Experience in P&L management, financial accountability, and a demonstrated ability to build...
- ...Vice President of Drug Safety About the Company Clinical stage biotechnology company advancing novel therapeutic candidates for autoimmune and inflammatory... ...and execution of all safety surveillance, risk management, and regulatory compliance activities across the...
- ...Vice President of Perioperative Services About the Company Leading... ...Healthcare Hospitals & Clinics Hospital Medical Business... ...allocation, financial management, and the establishment of patient... ...also be experienced in risk management, and technology integration...
- ...Vice President of Clinical Pharmacology About the Company Forward-thinking biotechnology company... ...and mitigating clinical pharmacology risks, providing strategic input for NDA/... ...candidate will possess strong project management skills, the ability to work both independently...
- ...Vice President, Clinical Development About the Company Well-funded clinical-stage biotech developing precision cardiovascular therapies... ...while helping to design future-state organizations. Hiring Manager Title CMO Functions ~ Medical Care/Hospital...
- ...Vice President, Clinical Education Services About the Company Reputable provider of advanced wound care & clinical nutrition products... ...education programs and customer engagement initiatives. Hiring Manager Title Senior Vice President, Clinical Services...
- ...Vice President, Pharmacovigilance and Safety About the Company Forward-thinking pharmaceutical... ...key, as the VP will work closely with clinical development, clinical operations,... ...a demonstrated ability to lead safety risk management and benefit-risk assessments. The VP...
- ...an alternative application process. Vice President, Program Management Full Time Malvern, PA, US 5 days... ...Requisition ID: 1007 Uniquity Bio is a clinical-stage biotechnology company... ...Anticipate and proactively mitigate risks related to enrollment, endpoints, regulatory...Full timeWork at officeLocal areaRemote work
$319.09k - $386.66k
...those who do it.Role: Vice President and Assistant General... ...compliance, mitigating risks, and providing strategic... ...for supply chain, clinical trials, regulatory issues... ...and helping manage the risk profile of the... ...applicable data privacy policies and regulations.If this...PolicyHourly payFull timeSummer workLive inLocal areaRemote workFlexible hoursRayzeBio
San Diego, CA11 days ago- ...Description Responsibilities: Manage end-to-end delivery of data... ...data management expertise to Clinical Data Management (CDM) team to... ...regulatory guidelines, SOPs, policies, and, where available, CDM... ..., required resources, risks, issues and milestone timing....PolicyWork at office
Katalyst HealthCares & Life Sciences
San Diego, CA2 days ago $171.6k - $338.3k
...multiple market segments ranging from R&D/Clinical through Commercialization.Recruiting for... ...-in-hand with Partners, Principals and Managing Directors, these sales executives focus... ...spending time in the field, and at conferences/policy forums in support of sales campaigns and...PolicyFor contractorsLocal areaDeloitte
San Diego, CAa month ago- ...Position Summary: The Vice President and Chief Human Resource Officer is responsible for leading... ..., ensuring sound business programs and policies.3. Serves as a strategic business... ...compensation and safety, and performance management.11. Confers with organization officials...PolicyLocal areaWeekend work
San Ysidro Health Center
San Diego, CA4 days ago - ...Vice President, Credit Risk, Data Science, Analytics & Strategy About the Company A fast-growing... ...will be responsible for owning credit policy and analytics across the credit... ...analytics space. Functions Data Management/Analytics Finance Strategy ConfidentialPolicy
- ...Vice President, Mortgage Risk (Non-QM) About the Company Mortgage lender focused on Non-QM and portfolio... ...and maintenance of mortgage credit policy, underwriting guidelines, and risk... ...record in developing, implementing, and managing mortgage underwriting guidelines and...Policy
$325k - $400k
...inclusive culture. JOB SUMMARY The Vice President, Head of Clinical Development – Allergy & Urticaria is... ...Operations, Biometrics & Data Management, Clinical Operations, Pharmacovigilance... ..., study designs, timelines, and risk/benefit tradeoffs. Author and oversee...ARS Pharmaceuticals Operations, Inc.
San Diego, CA17 days ago- ...Vice President of Programs About the Company Mission-driven foundation providing research... ...connector and bridge-builder across research, policy, and social movements. The successful... ...served by the organization. Hiring Manager Title President Functions ~ Non-...Policy
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Vice President, Clinical Policy & Risk Management. Be the first to apply!
- vice president program management San Diego, CA
- senior vice president human resources San Diego, CA
- vice president sales San Diego, CA
- vice president innovation San Diego, CA
- vice president logistics San Diego, CA
- vp product management San Diego, CA
- vice president global communications San Diego, CA
- vice president strategic initiatives San Diego, CA
- vice president information technology San Diego, CA
- vice president of revenue cycle San Diego, CA