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The Clinical Risk Management Lead supports clinical risk management activities across the Primary Care Organization (PCO) by identifying, assessing, monitoring, and mitigating risks related to clinical practice, patient care, regulatory compliance, and operational processes. This role partners with clinical and business leaders to evaluate risk exposure, assess existing controls, recommend improvements, and support the implementation of risk management strategies that align with organizational objectives. You will report to the Associate VP, Risk Management.
The position works closely with leaders across CenterWell Senior Primary Care, Conviva, and MaxHealth, as well as cross-functional partners in Compliance, Legal, Privacy, Human Resources, and Enterprise Health & Safety. The Clinical Risk Management Lead also serves as a clinical subject matter resource, providing guidance on clinical risk management, control design, issue mitigation, and regulatory considerations.
Key Responsibilities
- Conduct clinical risk assessments to identify, evaluate, and prioritize risks related to clinical operations, patient care, and healthcare delivery.
- Develop and execute clinical risk management plans, including assessment of existing controls and recommendations for risk mitigation strategies.
- Partner with clinical leadership to evaluate risks and support the implementation of effective controls and corrective actions.
- Present findings, recommendations, and risk mitigation strategies to leadership and key stakeholders.
- Collaborate with Compliance, Legal, Privacy, Human Resources, Enterprise Health & Safety, and other internal teams on risk-related initiatives.
- Identify, document, and support resolution of business issues related to clinical practice and operational processes.
- Guide business and clinical partners through risk mitigation and corrective action planning.
- Conduct research, gather information, interview stakeholders, and evaluate clinical risk scenarios to support objective risk assessments.
- Monitor emerging risks, trends, and regulatory requirements affecting primary care and value-based care operations.
- Support continuous improvement efforts related to risk management frameworks, controls, and clinical governance processes.
Use your skills to make an impact
Required Qualifications
- Bachelor's degree or higher in Nursing, Physician Assistant Studies, or a related clinical discipline.
- Active and unrestricted clinical license.
- 5+ years of clinical healthcare experience.
- Experience collaborating with clinical leadership and interdisciplinary stakeholders.
- Strong analytical, communication, problem-solving, and risk assessment skills.
- Ability to evaluate clinical processes, identify risks, and recommend practical solutions.
- Experience presenting recommendations and findings to leadership audiences.
Preferred Qualifications
- Advanced Practice Registered Nurse (APRN) or Physician Assistant (PA) designation.
- 3+ years of experience in risk management, compliance, audit, healthcare quality, patient safety, clinical operations, or related fields.
- Experience within value-based care, population health, primary care, Medicare Advantage, or managed care environments.
- Knowledge of healthcare regulations, internal controls, clinical governance, and risk management frameworks.
- Familiarity with healthcare operational processes, quality improvement initiatives, and regulatory compliance programs.
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Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$104,000 - $143,000 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 12-05-2026
