The mission of the Medicare and Medicaid Operational Risk Management Department is to partner with CM/UM teams to drive operational compliance, member access to care, and efficiency, while ...
The mission of the Medicare and Medicaid Operational Risk Management Department is to partner with CM/UM teams to drive operational compliance, member access to care, and efficiency, while ...
Clinical Risk Manager
Warner Robins, GA · On-site
Lead and support the system-wide clinical risk management program by assessing institutional risks, adverse events, and near misses. * Investigate and analyze actual and potential risks and recommend ...
Clinical Risk Manager
Warner Robins, GA · On-site
Lead and support the system-wide clinical risk management program by assessing institutional risks, adverse events, and near misses. * Investigate and analyze actual and potential risks and recommend ...
Lead and support the system-wide clinical risk management program by assessing institutional risks, adverse events, and near misses. * Investigate and analyze actual and potential risks and recommend ...
Lead and support the system-wide clinical risk management program by assessing institutional risks, adverse events, and near misses. * Investigate and analyze actual and potential risks and recommend ...
Clinical Risk Manager
Atlanta, GA · Hybrid
Develop, review, and revise risk management and patient safety policies to ensure compliance with federal, state, and accreditation standards * Monitor regulatory updates and communicate requirements ...
Clinical Risk Manager
Atlanta, GA · Hybrid
Develop, review, and revise risk management and patient safety policies to ensure compliance with federal, state, and accreditation standards * Monitor regulatory updates and communicate requirements ...
Staff Cybersecurity Analyst, Risk Management
Riverdale, GA · On-site
$140.60K - $186.36K/yr
Role Summary The Cybersecurity Analyst - Risk Management is a mid-career individual contributor supporting Rivian's cybersecurity risk management practice. This role involves day-to-day management of ...
Staff Cybersecurity Analyst, Risk Management
Riverdale, GA · On-site
$140.60K - $186.36K/yr
Role Summary The Cybersecurity Analyst - Risk Management is a mid-career individual contributor supporting Rivian's cybersecurity risk management practice. This role involves day-to-day management of ...
Staff Cybersecurity Analyst, Risk Management
Riverdale, GA · On-site
$140.60K - $186.36K/yr
Role Summary The Cybersecurity Analyst - Risk Management is a mid-career individual contributor supporting Rivian's cybersecurity risk management practice. This role involves day-to-day management of ...
Staff Cybersecurity Analyst, Risk Management
Riverdale, GA · On-site
$140.60K - $186.36K/yr
Role Summary The Cybersecurity Analyst - Risk Management is a mid-career individual contributor supporting Rivian's cybersecurity risk management practice. This role involves day-to-day management of ...
The mission of the Medicare and Medicaid Operational Risk Management Department is to partner with CM/UM teams to drive operational compliance, member access to care, and efficiency, while ...
The mission of the Medicare and Medicaid Operational Risk Management Department is to partner with CM/UM teams to drive operational compliance, member access to care, and efficiency, while ...
Intuit's FinTech organization is seeking an exceptional Manager 3 of Risk Operations. This key leadership role is responsible for overseeing financial risk mitigation (fraud/financial crimes) and ...
Intuit's FinTech organization is seeking an exceptional Manager 3 of Risk Operations. This key leadership role is responsible for overseeing financial risk mitigation (fraud/financial crimes) and ...
Overview Intuit's FinTech organization is seeking an exceptional Manager 3 of Risk Operations. This key leadership role is responsible for overseeing financial risk mitigation (fraud/financial crimes ...
Overview Intuit's FinTech organization is seeking an exceptional Manager 3 of Risk Operations. This key leadership role is responsible for overseeing financial risk mitigation (fraud/financial crimes ...
Risk Manager
Atlanta, GA · On-site
$140K - $170K/yr
Oversee the coordination and management of insurance policies and programs for the corporation, in ... Evaluate and select techniques to minimize losses such as risk retention, risk transfer, etc.
Risk Manager
Atlanta, GA · On-site
$140K - $170K/yr
Oversee the coordination and management of insurance policies and programs for the corporation, in ... Evaluate and select techniques to minimize losses such as risk retention, risk transfer, etc.
Enterprise Risk Manager
Atlanta, GA · Hybrid
Senior Director, Enterprise Risk Management Overview We are seeking a forward-thinking Enterprise Risk Manager to strengthen our risk assessment capabilities by integrating advanced analytics and AI ...
Enterprise Risk Manager
Atlanta, GA · Hybrid
Senior Director, Enterprise Risk Management Overview We are seeking a forward-thinking Enterprise Risk Manager to strengthen our risk assessment capabilities by integrating advanced analytics and AI ...
This position is responsible for deploying risk management practices to the IT/OT footprint at GPI, and to provide leadership with transparency into GPI's risk exposure for both IT and OT ...
This position is responsible for deploying risk management practices to the IT/OT footprint at GPI, and to provide leadership with transparency into GPI's risk exposure for both IT and OT ...
Architect and lead the transformation of the Cyber Third-Party Risk Management (CTPRM) operating model, embedding agentic AI, automation, and intelligent workflows to significantly improve ...
Architect and lead the transformation of the Cyber Third-Party Risk Management (CTPRM) operating model, embedding agentic AI, automation, and intelligent workflows to significantly improve ...
Risk Management, RN
Cumming, GA · On-site
Experience in medical malpractice claim management, medical record review, or legal nurse consultant experience. * Demonstrated computer knowledge.
Risk Management, RN
Cumming, GA · On-site
Experience in medical malpractice claim management, medical record review, or legal nurse consultant experience. * Demonstrated computer knowledge.
Experience in medical malpractice claim management, medical record review, or legal nurse consultant experience. * Demonstrated computer knowledge. 8AM-430PM No No
Experience in medical malpractice claim management, medical record review, or legal nurse consultant experience. * Demonstrated computer knowledge. 8AM-430PM No No
Risk Management, RN
Cumming, GA · On-site
Experience in medical malpractice claim management, medical record review, or legal nurse consultant experience. * Demonstrated computer knowledge. Work Hours: 8AM-430PM Weekend Requirements: No ...
Risk Management, RN
Cumming, GA · On-site
Experience in medical malpractice claim management, medical record review, or legal nurse consultant experience. * Demonstrated computer knowledge. Work Hours: 8AM-430PM Weekend Requirements: No ...
Experience in medical malpractice claim management, medical record review, or legal nurse consultant experience. * Demonstrated computer knowledge. Work Hours (EX:7AM-7PM):8AM-430PMWeekend ...
Experience in medical malpractice claim management, medical record review, or legal nurse consultant experience. * Demonstrated computer knowledge. Work Hours (EX:7AM-7PM):8AM-430PMWeekend ...
Voya risk management professionals aspire, individually and collectively, to actively participate in Voya's growth strategy as trusted advisers to the business and enablers of growth, with a focus on ...
Voya risk management professionals aspire, individually and collectively, to actively participate in Voya's growth strategy as trusted advisers to the business and enablers of growth, with a focus on ...
Voya risk management professionals aspire, individually and collectively, to actively participate in Voya's growth strategy as trusted advisers to the business and enablers of growth, with a focus on ...
Voya risk management professionals aspire, individually and collectively, to actively participate in Voya's growth strategy as trusted advisers to the business and enablers of growth, with a focus on ...
Serve as the internal owner and day-to-day liaison with the external captive manager, captive ... Serve as the senior business owner for the Risk Management Information System (Origami), with ...
Serve as the internal owner and day-to-day liaison with the external captive manager, captive ... Serve as the senior business owner for the Risk Management Information System (Origami), with ...
Manager Disaster Risk Management information
What are the key skills and qualifications needed to thrive as a Manager Disaster Risk Management, and why are they important?
What are some common challenges faced by a Manager Disaster Risk Management when coordinating response efforts across different departments?
What is a Manager Disaster Risk Management?
What is the difference between Manager Disaster Risk Management vs Emergency Response Coordinator?
| Aspect | Manager Disaster Risk Management | Emergency Response Coordinator |
|---|---|---|
| Credentials | Certifications in disaster management, risk assessment, project management | Certifications in emergency response, first aid, crisis management |
| Work Environment | Strategic planning, policy development, risk analysis in offices or field sites | On-the-ground response, coordination during emergencies, field operations |
| Employer & Industry | Government agencies, NGOs, corporations focusing on disaster preparedness | Emergency services, fire departments, disaster response agencies |
| Search & Comparison Intent | Focuses on risk management and planning roles | Focuses on immediate response and operational coordination |
The main difference is that a Manager Disaster Risk Management focuses on strategic planning, risk assessment, and preparedness to prevent or mitigate disasters, while an Emergency Response Coordinator handles immediate response efforts during emergencies. Both roles are vital but differ in scope, responsibilities, and work environment.
Humana rating
8.0
Based on 251 frontline employees who took The Breakroom Quiz
144th of 259 rated insurance
Job description
Humana maintains a robust clinical risk management function to ensure effective risk mitigation, control, and governance processes across Care Management and Utilization Management. The mission of the Medicare and Medicaid Operational Risk Management Department is to partner with CM/UM teams to drive operational compliance, member access to care, and efficiency, while proactively identifying and managing risks related to care and utilization management.
The Vice President, Clinical Policy and Risk Management will oversee a department comprising 5 direct reports that lead CM/UM Risk Management, UM and CM audit teams, policy governance and clinical learning. This role reports directly to the Senior Vice President - Clinical Operations.
Responsibilities
- Identify, assess, and report operational and clinical risks within CM/UM processes to appropriate governance structures.
- Monitor CM/UM compliance and operational metrics, ensuring escalation and resolution of any issues impacting member care or regulatory compliance.
- Track, interpret, and implement CMS Federal and Medicaid State regulations impacting CM/UM, ensuring timely and complete adoption.
- Support regulatory audits with emphasis on CM/UM compliance and facilitate remediation where necessary.
- Lead risk mitigation efforts related to care management and utilization management, including maturity assessments and oversight of issues and opportunities.
- Oversee CM/UM business continuity and work across leadership to resolve any IOPs administered.
- Foster quality and continuous improvement within CM/UM control processes, ensuring alignment with policies, standards, and applicable laws.
- Address legislative and regulatory issues with potential impact on CM/UM operations, including fraud risk identification and mitigation.
- Lead the strategy, design, implementation, and continuous improvement of clinical learning programs that support onboarding, role readiness, compliance, and performance for Care Management and Utilization Management teams; oversee end-to-end learning solution development, including curriculum architecture, instructional design standards, learning technologies and systems administration, workflow integration, and new hire onboarding experiences
- Partner closely with clinical, operational, compliance, and business leaders to ensure learning content is aligned to regulatory requirements, clinical processes, system functionality, and business priorities; establish scalable onboarding and learning pathways, optimize learner experience across platforms, and use performance data, audit findings, and operational insights to strengthen adoption, reduce risk, and improve readiness and effectiveness of the clinical workforce.
Use your skills to make an impact
Required Qualifications
- Bachelor's degree
- Extensive experience (10+ years) in CM/UM risk management, regulatory compliance, process improvement, or related fields, with several years in leadership roles.
- Advanced knowledge of CM/UM operational controls, risk mitigation strategies, and regulatory requirements for Medicare and Medicaid.
- Demonstrated expertise in internal controls, clinical and operational risk management, and IT technical controls within CM/UM environments.
- Exceptional project management skills, integrity, and business ethics.
- Ability to collaborate with stakeholders across the enterprise and influence outcomes in complex, matrixed environments.
- Excellent communication skills and executive presence.
Preferred Qualifications
- MBA
- Relevant professional credentials (CPA, CIA, CISSP, JD, SOA, RN, CCM, or similar)
Scheduled Weekly Hours
40About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand 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.
About Humana
Sourced by ZipRecruiter
Humana Inc., headquartered in Louisville, KY., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Louisville, KY, US
Year founded
1961