VP, Clinical Policy and Risk Management

About the role

Our client, a leader in the healthcare space, is seeking a VP, Clinical Policy and Risk Management. This highly visible leadership position shapes clinical policy oversight with a strong focus on care and utilization management processes, regulatory compliance, and risk mitigation. The role partners closely with operational and clinical leaders to strengthen audit readiness, business continuity, and continuous improvement across the organization, ensuring effective governance and disciplined execution in a regulated healthcare environment.

Location: Remote – U.S.‑based candidates only (no visa sponsorship).

Responsibilities

• Identify and report clinical risks in care management and utilization management processes.
• Monitor compliance and operational metrics, addressing issues promptly.
• Track and implement changes in CMS federal and Medicaid state regulations.
• Support regulatory audits for care management and utilization management compliance.
• Lead efforts to mitigate risks related to care and utilization management.
• Oversee business continuity and collaborate with leadership.
• Enhance quality and continuous improvement of care management and utilization management processes.

Qualifications

• Bachelor’s degree required; MBA preferred.
• Active, unrestricted clinical license in an applicable discipline (e.g., RN, LCSW, LPC, LMFT, PharmD, or MD/DO).
• 10+ years of experience in care management or utilization management risk management or regulatory compliance.
• 6+ years in leadership roles.
• Advanced understanding of Medicare and Medicaid regulatory requirements.
• Proven expertise in clinical and operational risk management processes.
• Exceptional project management and communication skills.

Benefits

• Remote work flexibility.
• Potential occasional travel for meetings.
• Supportive corporate culture emphasizing continuous improvement.
• Collaboration with cross‑functional teams on regulatory and compliance matters.

Pay

Compensation: $160,000 – $200,000 annually.