VP, Clinical Policy & Risk Management
Waterside Bldg, United States
USD 223K-313K (estimate) Executive-level Full Time
Tasks
- Address legislative and regulatory issues impacting CM and UM operations
- Administer learning technologies and systems
- Align learning content with regulatory requirements and clinical processes
- Assess and report operational and clinical risks to governance
- Conduct maturity assessments and oversee risk issues and opportunities
- Design curriculum architecture and instructional design standards
- Escalate and resolve issues impacting member care and compliance
- Foster quality and continuous improvement in control processes
- Identify and mitigate fraud risk
- Identify clinical risks in care management and utilization management processes
- Integrate learning workflows and support new hire onboarding
- Lead clinical learning program strategy and implementation
- Lead risk mitigation efforts for care management and utilization management
- Monitor CM and UM compliance and operational metrics
- Oversee CM and UM business continuity
- Resolve leadership escalations and operational issues
- Support regulatory audits and drive remediation
- Track and implement CMS federal regulations and Medicaid state regulations
- Use performance data to improve adoption and readiness
Perks/Benefits
- N/A
Skills/Tech-stack
Audit Remediation | Business Continuity | CMS Regulations | Clinical Learning | Curriculum Development | Fraud risk | Fraud risk management | Governance | Instructional Design | Internal Controls | Learning Technologies | Learning management | Learning management systems | Management systems | Medicaid regulations | Operational Metrics | Process Improvement | Project Management | Regulatory Compliance | Risk Management | Stakeholder management
Education
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