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
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Vice President, Clinical Policy & Risk Management in Houston, TX vacancy
- ...Job Description Job Description Vice President of Clinical ServicesNexus Health Systems Nexus Health... ...system-level clinical standards, policies, and procedures into consistent and sustainable... ...operational deployment of quality management systems, performance improvement...PolicyTemporary workLocal area
Nexus Health Systems Ltd
Houston, TX11 days ago - ...The Vice President of Revenue Cycle will be responsible for... ...Execution Lead and manage internal RCM teams and... ...performance Compliance & Risk Management Ensure... ...compliance teams on policy development Growth... ...processes for new clinics and providers Support...Policy
PsychPlus
Houston, TX2 days ago $100k - $160k
...real estate, construction, and hospitality sectors. We offer comprehensive risk management solutions, utilizing market-leading technologies to enhance underwriting, claims handling, and policy servicing. Our founder owns companies within these industries, providing us...PolicyFull timeRelocationShift workBenchmark Insurance Group & Rise Group
Houston, TXa month ago- ...Vice President of Information Security About the Company A growing mortgage and... ...organization. Key responsibilities include managing security operations, leading... ...efforts, and establishing security policies that balance risk with operational efficiency. The role...Policy
$150k - $175k
...Description Reports To - President and CEO Direct... ...Director, Audience Services Manager Status - Regular... ...weekends OVERVIEW The Vice President of Operations... ...plans, systems, policies, and accountability structures... ...preparedness, risk management, accessibility...PolicyFull timePart timeCasual workWork at officeLocal areaRemote workNight shiftWeekend workThe Hobby Center for the Performing Arts
Houston, TX17 days ago- ...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
- ...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
$250k - $275k
...your career with Eurest. Job Summary The Senior Vice President, Military Operations is a key member of the... ...business objectives. Ensure consistent execution of policies, procedures, compliance standards, and risk management practices across all locations. Drive...PolicyLocal areaRemote workRelocation packageFlexible hours$125k - $150k
...Position Overview:The Assistant Vice President (AVP) - Primary Casualty... ...responsible for leading and managing the organization’s primary casualty... ...in alignment with company policies and regulatory requirements.Review... ...with underwriting, risk management, legal, and other...PolicyFull timeWorldwideStarr Companies
Houston, TX6 days ago- ...expertise to JPMorganChase. As part of Risk Management and Compliance, you are at the center... ...in-class. As a Lead Credit Officer - Vice President within the Commercial and Investment Bank... ...materials, ensuring all credit risk policies are followedReview and negotiate legal...PolicyWork at office
JP Morgan Chase
Houston, TXa month ago $120k - $160k
...Assistant Vice President, Global Travel Lead Boston; Houston, Texas,... ...that offers alternative asset management as well as capital markets and... ...Maintain alignment between travel policy, company values, and business... ...current on travel trends, risk management practices, and...PolicyContract workWork at officeLocal area- ...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
- ...segments—Institutional Securities, Wealth Management (WM), and Asset Management. Morgan... ...The WM and U.S. Banks Financial Crimes Risk Team is embedded within the Firm’s business... ...all relevant Financial Crimes standards, policies, procedures and applicable laws and regulations...PolicyFull time
Morgan Stanley
Houston, TXa month ago - ...Job Description Job Description The Vice President, Information Security will build the... ...company's security posture, mature our risk management capabilities, and build a security-... ...security events. Establish security policies, standards, and procedures that balance...Policy
Gateway Recruiting
Houston, TX8 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
- ...INNOVATE Role Overview The Vice President of Operations is responsible... ...implementation of strategic operational policies and practices. This role is... ...key areas: Leadership, Management, Accountability Provides... ...operations of outpatient clinics and related support services...PolicyWork at office
- ...Description Job Description Vice President of IT Operations Nexus Health Systems... ...executive leadership for Clinical Informatics and the IT Project Management Office (PMO), oversees enterprise... ...executive-level communication regarding risks, priorities, and organizational...Full timeContract workWork at office
Nexus Health Systems Ltd
Houston, TX17 days ago $160k - $200k
...200,000.00 SalaryVice President of Operations Why Work... ...you? Competitive pay Clinical/Corporate Career Advancement... .... A people-first manager who hires well, coaches... ...Concerto is seeking a Vice President of... ...maintenance and development of policies and procedures that reflect...PolicyTemporary workWork at office- ...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, 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, 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...
- ...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, Strategic Finance About the Company Innovative community-based healthcare... ...Medical Care Health Centers Clinics Outpatient Outpatient Care About... ..., capital planning, enterprise risk management, and organizational growth. The successful...
- ...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 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 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...
- ...public. The Associate Vice President (AVP), Talent... ...compliance with applicable policies and regulations. The AVP... ...trends, and talent risk mitigation strategies.... ...Contingent Workforce Management • Onboarding KEY... ...critical talent across clinical, research, academic, and...PolicyFull timeTraineeshipLocal areaRemote workRelocationRelocation package
MD Anderson
Houston, TX2 days ago - ...expertise to JPMorgan Chase. As part of Risk Management and Compliance, you are at the center... ...Summary: As a Lead Credit Officer Vice President in Business Banking Risk, you oversee,... ...while applying sound credit judgment and policy expertise. You will also synthesize...PolicyVisa sponsorship
JPMorgan Chase & Co.
Houston, TX9 days ago - ...Credit OfficerBring your expertise to JPMorgan Chase. As part of Risk Management and Compliance, you are at the center of keeping JPMorgan... ...Skills:Advanced degree (Master's) in real estate, finance, public policy, or related discipline.Experience closing complex, multi?...PolicyPermanent employmentWork at officeLocal area
- ...Expertise to JPMorgan Chase. As part of Risk Management and Compliance, you are at the center... ...As a Global Commodities Credit Risk - Vice President within the Commercial & Investment... ...business initiatives, change management, policy, procedure, product control, regulatory...PolicyWork experience placementWork at office
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Vice President, Clinical Policy & Risk Management. Be the first to apply!
Related searches
- vice president program management Houston, TX
- senior vice president human resources Houston, TX
- vice president sales Houston, TX
- vice president innovation Houston, TX
- vice president logistics Houston, TX
- vp product management Houston, TX
- vice president global communications Houston, TX
- vice president strategic initiatives Houston, TX
- vice president information technology Houston, TX
- vice president of revenue cycle Houston, TX