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
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