Regional VP, Health Services

This is a fully remote position, open to applicants in United States.

📋 Description

• Provide leadership and clinical strategy based on market insights for Humana Healthy Horizons in Indiana.

• Supervise clinical operations, quality, utilization management, population health, and strategies for medical costs.

• Act as the senior clinical representative for the State, providers, community partners, and various stakeholders.

• Deliver strategic and operational clinical guidance for Indiana Medicaid lines of business, encompassing Medicaid-only, Medicaid LTSS, integrated Medicare-Medicaid products, and integrated D-SNP.

• Assist in Medicaid business development, procurement strategies, stakeholder engagement, competitive market positioning, provider partnership opportunities, and innovative clinical solutions.

• Provide medical leadership and strategic direction for Health Services Operations with fiscal accountability for trend management.

• Collaborate with internal and external stakeholders in a complex, matrixed environment.

• Oversee utilization management, care management, quality operations, and strategies for medical necessity.

• Direct clinical strategy, performance, compliance, and operational efficiency of care management programs.

• Lead market-level clinical initiatives and quality improvement projects, including HEDIS/STARS performance, peer review activities, and governance of the Quality Management Committee.

• Partner with providers, facilities, and ancillary networks to enhance relationships, support contracting activities, and promote value-based and risk-sharing arrangements.

⛳️ Requirements

• M.D. or D.O. degree required.

• Must possess a current, unrestricted medical license and board certification.

• Ability to practice medicine in Indiana.

• At least 10 years of progressive clinical and healthcare leadership experience.

• Experience in managed care, Medicaid, Medicare, or environments focused on value-based care.

• Demonstrated experience leading strategies for utilization management, care management, quality improvement, population health, and medical cost management.

• Capability to influence executive leaders, state partners, and cross-functional teams.

• Experience collaborating with providers, health systems, community organizations, and governmental stakeholders.

• Strong skills in strategic planning, financial acumen, and executive leadership.

• Familiarity with state Medicaid agencies, CMS, accreditation organizations, and regulatory oversight entities.

• Minimum home internet speed of 25 Mbps download and 10 Mbps upload required.

• 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 direct patient interaction.

• Preferred: clinical specialization in Internal Medicine, Family Practice, Geriatrics, Hospitalist, ER, or PM&R.

• Preferred: Master's Degree.

🏝️ Benefits

• Bonus incentive plan based on company and/or individual performance.

• Comprehensive medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company-specific and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance.

• Dedicated workspace for remote work.

• Flexible remote work arrangements.

• Occasional travel to Humana offices for training or meetings.