Humana

Regional VP, Health Services Central Region

Humana

full-time

Posted on:

Origin:  • 🇺🇸 United States • Illinois, Kansas, Missouri, Wisconsin

Visit company website
✨ AI Apply
Manual Apply

Salary

💰 $298,000 - $409,800 per year

Job Level

Lead

About the role

  • Cultivate and maintain trusted relationships with CMOs and senior executive/clinical leaders at provider and care delivery partner organizations
  • First and foremost, this is a role focused on building relationships with providers, and then leveraging those relationships to collaborate on how to positively drive provider performance, overcome operational barriers and reduce administrative burden
  • Serve as lead clinical executive for provider groups, translating clinical and quality priorities into actionable strategies
  • This includes promoting growth strategies and innovation with all provider groups, particularly our CenterWell partners
  • Enhance innovation with hospital systems while fostering collaboration and reducing operational barriers
  • Drive population health initiatives to improve the health and well-being of our members including: A strong understanding of clinical metrics and data (e.g. Quality measures, Risk Adjustment ratings, chronic condition management, PCP visit rates and effectiveness, and member engagement strategies)
  • Identifying and implementing initiatives to address total cost of care drivers
  • Championing condition-based interventions
  • Leading clinical strategies to manage unique populations, such as unattributed membership, low income, disabled, or special needs members
  • Clinical Strategy & Market Performance: Serve as the clinical steward for regional medical expense trends, leveraging data to guide interventions, and ensure fiscal accountability
  • Collaborate with finance, analytics, and market leadership to identify cost and quality outliers and implement targeted action plans
  • Customize strategies to align clinical programs with payer-specific needs (MA, D-SNP)
  • Provide clinical input into network development, contract negotiations, and delegation oversight
  • Serve as clinical subject matter for potential plan design and clinical programs to support continued health plan growth
  • Represent the organization in regional health coalitions and community health initiatives
  • Collaborate with various operational functions in the centralized utilization management team and other shared services
  • Participate in quality governance, peer review, and grievance resolution processes
  • Innovation & Transformation: Partner with national innovation teams to pilot and scale emerging technologies and care models (e.g., remote monitoring, clinical pathways, tech-enabled care)
  • Lead regional implementation of clinical focused strategic programs
  • Collaborate with vendor partnerships and evaluate performance against clinical and financial KPIs
  • May also be involved in governance committees and delegation oversight

Requirements

  • Active MD or DO licensure with appropriate training and certification
  • 5+ years clinical practice
  • 5+ years in managed care industry, either provider or payer
  • Thorough knowledge of health care utilization and quality metrics and the impact value-based contracting has on provider behavior and performance
  • The ability to quickly monitor clinical metrics and convey the impact verbally and in writing
  • Proficient communication skills, including interpersonal, written and presentation, and the ability to promote complex material in a way that can be understood and acted upon by others
  • Strategic thinker with the ability to balance long-term vision and short-term execution
  • Established track record of building successful teams and cross departmental relationships
  • Travel required 25-30%