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 ...
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 ...
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 ...
The Manager, Risk Management is responsible for facility-wide risk management activities, that include risk management operations, loss prevention including patient safety, claims management, risk ...
The Manager, Risk Management is responsible for facility-wide risk management activities, that include risk management operations, loss prevention including patient safety, claims management, risk ...
Insurance & Risk Manager
Oak Ridge, TN · On-site
... cost models Requirements REQUIREMENTS: * Bachelor's degree in finance, business, law, or related discipline. * 10-15 years of progressive experience in corporate insurance, risk management, or ...
Insurance & Risk Manager
Oak Ridge, TN · On-site
... cost models Requirements REQUIREMENTS: * Bachelor's degree in finance, business, law, or related discipline. * 10-15 years of progressive experience in corporate insurance, risk management, or ...
The Opportunity As a Risk Management - Contract Specialist - Managed Services - Senior Manager, you will lead initiatives in enterprise risk management, focusing on business continuity, risk model ...
The Opportunity As a Risk Management - Contract Specialist - Managed Services - Senior Manager, you will lead initiatives in enterprise risk management, focusing on business continuity, risk model ...
The Manager, Risk Management is responsible for facility-wide risk management activities, that include risk management operations, loss prevention including patient safety, claims management, risk ...
The Manager, Risk Management is responsible for facility-wide risk management activities, that include risk management operations, loss prevention including patient safety, claims management, risk ...
Risk Manager - Insurance
$110K - $145K/yr
Bachelor's degree in Risk Management, Finance, Business, Insurance (or a related field), active P&C license Please note: If this position is posted as either fully remote and/or hybrid, in accordance ...
Risk Manager - Insurance
$110K - $145K/yr
Bachelor's degree in Risk Management, Finance, Business, Insurance (or a related field), active P&C license Please note: If this position is posted as either fully remote and/or hybrid, in accordance ...
Risk & Independence Contract Specialist Senior Manager - Advisory Consulting Services
Nashville, TN · On-site
... management, focusing on business continuity and risk model implementation. You will guide teams in identifying and mitigating risks, confirming that operations and core business functions remain ...
Risk & Independence Contract Specialist Senior Manager - Advisory Consulting Services
Nashville, TN · On-site
... management, focusing on business continuity and risk model implementation. You will guide teams in identifying and mitigating risks, confirming that operations and core business functions remain ...
... management programs. The Treasury group owns the frameworks, models, and execution strategies that protect the company from volatility in aluminum and other key inputs, while also overseeing the ...
... management programs. The Treasury group owns the frameworks, models, and execution strategies that protect the company from volatility in aluminum and other key inputs, while also overseeing the ...
Senior VP of Program Management Your role in the mission: The Director of Risk & Opportunity will ... This role will partner cross-functionally to develop cost models, lead value engineering ...
Senior VP of Program Management Your role in the mission: The Director of Risk & Opportunity will ... This role will partner cross-functionally to develop cost models, lead value engineering ...
The Director of Risk Management is responsible for the timely and accurate collection, flow and processing of data for risk adjustment activities. This role will establish, monitor, and maintain the ...
The Director of Risk Management is responsible for the timely and accurate collection, flow and processing of data for risk adjustment activities. This role will establish, monitor, and maintain the ...
The Director of Risk Management is responsible for the timely and accurate collection, flow and processing of data for risk adjustment activities. This role will establish, monitor, and maintain the ...
The Director of Risk Management is responsible for the timely and accurate collection, flow and processing of data for risk adjustment activities. This role will establish, monitor, and maintain the ...
The Director of Risk Management is responsible for the timely and accurate collection, flow and processing of data for risk adjustment activities. This role will establish, monitor, and maintain the ...
The Director of Risk Management is responsible for the timely and accurate collection, flow and processing of data for risk adjustment activities. This role will establish, monitor, and maintain the ...
Risk and Safety Manager
Nashville, TN · On-site
Assisting in preparing and maintaining risk management and insurance budgets. • Ensure compliance with regulatory bodies for local, state, and federal regulations, including OSHA, DOT, and EPA ...
Risk and Safety Manager
Nashville, TN · On-site
Assisting in preparing and maintaining risk management and insurance budgets. • Ensure compliance with regulatory bodies for local, state, and federal regulations, including OSHA, DOT, and EPA ...
Assisting in preparing and maintaining risk management and insurance budgets. • Ensure compliance with regulatory bodies for local, state, and federal regulations, including OSHA, DOT, and EPA ...
Quick apply
Assisting in preparing and maintaining risk management and insurance budgets. • Ensure compliance with regulatory bodies for local, state, and federal regulations, including OSHA, DOT, and EPA ...
Global Tax Risk Management- Manager
Nashville, TN · On-site
$73.50K - $244K/yr
The Opportunity As part of the Global Network Tax team, you will be an integral part of navigating tax risk management for the entire network. As a Manager, you will inspire and develop your team ...
Global Tax Risk Management- Manager
Nashville, TN · On-site
$73.50K - $244K/yr
The Opportunity As part of the Global Network Tax team, you will be an integral part of navigating tax risk management for the entire network. As a Manager, you will inspire and develop your team ...
Develop and update risk management plans as needed. Prepare action plans to decrease risk factors. Lead a Safety Committee educating leadership about the most significant risks to the business. Lead ...
Develop and update risk management plans as needed. Prepare action plans to decrease risk factors. Lead a Safety Committee educating leadership about the most significant risks to the business. Lead ...
... management programs. The Treasury group owns the frameworks, models, and execution strategies that protect the company from volatility in aluminum and other key inputs, while also overseeing the ...
... management programs. The Treasury group owns the frameworks, models, and execution strategies that protect the company from volatility in aluminum and other key inputs, while also overseeing the ...
Model Validation Director
Nashville, TN · On-site +1
Build, enhance or localize model risk management programs including coverage assessments, change management, access management procedures, internal controls, and transaction monitoring and watchlist ...
Model Validation Director
Nashville, TN · On-site +1
Build, enhance or localize model risk management programs including coverage assessments, change management, access management procedures, internal controls, and transaction monitoring and watchlist ...
Manager Model Risk Management information
What is the difference between Manager Model Risk Management vs Model Risk Analyst?
| Aspect | Manager Model Risk Management | Model Risk Analyst |
|---|---|---|
| Credentials | Typically requires advanced degrees (e.g., MBA, Master's in Finance or Risk), certifications like FRM or CFA | Often requires similar credentials, such as FRM or CFA, but may have less emphasis on managerial certifications |
| Work Environment | Leads teams, manages risk frameworks, and interacts with senior management | Performs detailed risk analysis, supports model validation, and reports findings |
| Employer & Industry Usage | Common in banking, asset management, and financial institutions | Found in similar environments, often as a supporting role to managers |
The Manager Model Risk Management oversees the entire model risk framework, manages teams, and interacts with senior stakeholders. In contrast, the Model Risk Analyst focuses on detailed analysis, validation, and reporting of models. Both roles require similar credentials but differ in scope and responsibilities.
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Humana rating
8.0
Based on 251 frontline employees who took The Breakroom Quiz
145th of 259 rated insurance
Job description
Become a part of our caring community
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.
Use your skills to make an impact
About 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.
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