Clinical Risk Management Lead

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The Clinical Risk Management Lead supports clinical risk management activities across the Primary Care Organization (PCO) by identifying, assessing, monitoring, and mitigating risks related to clinical practice, patient care, regulatory compliance, and operational processes. This role partners with clinical and business leaders to evaluate risk exposure, assess existing controls, recommend improvements, and support the implementation of risk management strategies that align with organizational objectives. You will report to the Associate VP, Risk Management.

The position works closely with leaders across CenterWell Senior Primary Care, Conviva, and MaxHealth, as well as cross-functional partners in Compliance, Legal, Privacy, Human Resources, and Enterprise Health & Safety. The Clinical Risk Management Lead also serves as a clinical subject matter resource, providing guidance on clinical risk management, control design, issue mitigation, and regulatory considerations.

Key Responsibilities

• Conduct clinical risk assessments to identify, evaluate, and prioritize risks related to clinical operations, patient care, and healthcare delivery.

• Develop and execute clinical risk management plans, including assessment of existing controls and recommendations for risk mitigation strategies.

• Partner with clinical leadership to evaluate risks and support the implementation of effective controls and corrective actions.

• Present findings, recommendations, and risk mitigation strategies to leadership and key stakeholders.

• Collaborate with Compliance, Legal, Privacy, Human Resources, Enterprise Health & Safety, and other internal teams on risk-related initiatives.

• Identify, document, and support resolution of business issues related to clinical practice and operational processes.

• Guide business and clinical partners through risk mitigation and corrective action planning.

• Conduct research, gather information, interview stakeholders, and evaluate clinical risk scenarios to support objective risk assessments.

• Monitor emerging risks, trends, and regulatory requirements affecting primary care and value-based care operations.

• Support continuous improvement efforts related to risk management frameworks, controls, and clinical governance processes.

Use your skills to make an impact

Required Qualifications

• Bachelor's degree or higher in Nursing, Physician Assistant Studies, or a related clinical discipline.

• Active and unrestricted clinical license.

• 5+ years of clinical healthcare experience.

• Experience collaborating with clinical leadership and interdisciplinary stakeholders.

• Strong analytical, communication, problem-solving, and risk assessment skills.

• Ability to evaluate clinical processes, identify risks, and recommend practical solutions.

• Experience presenting recommendations and findings to leadership audiences.

Preferred Qualifications

• Advanced Practice Registered Nurse (APRN) or Physician Assistant (PA) designation.

• 3+ years of experience in risk management, compliance, audit, healthcare quality, patient safety, clinical operations, or related fields.

• Experience within value-based care, population health, primary care, Medicare Advantage, or managed care environments.

• Knowledge of healthcare regulations, internal controls, clinical governance, and risk management frameworks.

• Familiarity with healthcare operational processes, quality improvement initiatives, and regulatory compliance programs.

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Work at Home Requirements

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$104,000 - $143,000 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 12-05-2026

About us

About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient’s well-being.

About CenterWell, a Humana company: CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer atCenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Centerwell, a wholly owned subsidiary of Humana, complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and language options