Vice President of Development
Rockstar
Regional VP, Health Services
Humana
full-time
Posted on:
Location Type: Remote
Location: Remote • Louisiana • 🇺🇸 United States
Visit company websiteSalary
💰 $298,000 - $409,800 per year
Job Level
Lead
About the role
- Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTAC, Acute rehab, SNF) according to the Humana Medicaid Model of Care.
- Participate in Quality Operations including chair Quality Management Committee, complete initial peer review on quality of care complaints, complete peer-to-peer written and verbal communications.
- Oversee administrative budget for regional HSO & Quality Improvement including approve/deny expense reports & requisition requests for department members.
- Oversee Quality Improvement and HEDIS/STARS metrics improvement with PCP offices and IPAs.
- Participate in regional level committees and meetings setting medical necessity strategies.
- Provide oversight and direction for the implementation of regional clinical programs and strategies, as well as, developing and implementing market level strategies.
- Manage internal operational/functional relationships related to profitability.
- Assist with network development and provider contracting with various providers and ancillary providers.
- Serve as clinical liaison with inpatient facilities and joint operating committees to maintain facility relationship and problem solve; especially reviewing contracts as to clinical services.
- Well-versed on financial aspects of various levels of risk bearing contracts and possess the ability to gain traction and adoption of the providers.
- Ability to thrive in a highly matrix environment.
Requirements
- 8 or more years of management experience
- Must live in Louisiana and have a current/unrestricted Louisiana medical license and willing to obtain license, as required, for various states in region of assignment.
- MD or DO degree
- Board Certified in an approved ABMS Medical Specialty
- Excellent communication skills
- 5 years of established clinical experience
- Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products
- Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Benefits
- medical, dental and vision benefits
- 401(k) retirement savings plan
- time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
- short-term and long-term disability
- life insurance
- many other opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
utilization managementcase managementquality managementHEDISSTARS metricsclinical programsprovider contractingdischarge planninghome healthrehab
Soft skills
communication skillsleadershipproblem solvinginterpersonal skillsorganizational skillsteam managementstrategic thinkingadaptabilitycollaborationpassion for improvement
Certifications
Louisiana medical licenseMD degreeDO degreeBoard Certified in ABMS Medical Specialty
