Regional VP, Health Services

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $327.7k - $450.6k / year

⏰ Full Time

🔴 Lead

👔 Vice President

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Provide market-based medical leadership and clinical strategy for Humana Healthy Horizons in Indiana • Oversee clinical operations, quality, utilization management, population health, and medical cost strategy • Serve as senior clinical representative to the State, providers, community partners, and other stakeholders • Provide strategic and operational clinical leadership for Indiana Medicaid lines of business, including Medicaid-only, Medicaid LTSS, integrated Medicare-Medicaid products, and integrated D-SNP • Support Medicaid business development, procurement strategy, stakeholder engagement, competitive market positioning, provider partnership opportunities, and innovative clinical solutions • Provide medical leadership and strategy for Health Services Operations with fiscal responsibility for trend management • Collaborate across internal and external stakeholders in a highly matrixed environment • Oversee utilization management, care management, quality operations, and medical necessity strategies • Lead clinical strategy, performance, compliance, and operational effectiveness of care management programs • Lead market-level clinical programs and quality improvement initiatives, including HEDIS/STARS performance, peer review activities, and Quality Management Committee governance • Partner with providers, facilities, and ancillary networks to strengthen relationships, support contracting activities, and drive value-based and risk-sharing arrangements

🎯 Requirements

• M.D. or D.O. degree • Current, unrestricted medical license and board certification • Ability to practice in Indiana • 10+ years of progressive clinical and healthcare leadership experience • Experience in managed care, Medicaid, Medicare, or value-based care environments • Proven experience leading utilization management, care management, quality improvement, population health, and medical cost management strategies • Ability to influence executive leaders, state partners, and cross-functional teams • Experience partnering with providers, health systems, community organizations, and government stakeholders • Strong strategic, financial, and executive leadership skills • Experience working directly with state Medicaid agencies, CMS, accreditation organizations, and regulatory oversight entities • Minimum home internet speed of 25 Mbps download and 10 Mbps upload • Preferred: senior clinical leadership experience in Medicaid managed care, integrated care, MLTSS, D-SNP, FIDE-SNP, or other Medicare-Medicaid integrated models • Preferred: medical management experience with health insurance organizations, hospitals, healthcare providers, and patient interaction • Preferred: Internal Medicine, Family Practice, Geriatrics, Hospitalist, ER, PM&R clinical specialization • Preferred: Master's Degree

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical, dental, and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Dedicated work-from-home space • Remote work arrangement • Occasional travel to Humana offices for training or meetings