Humana
Regional VP, Health Services - Midwest Region
Join to apply for the
Regional VP, Health Services - Midwest Region
role at
Humana . Overview
The Regional VP, Health Services relies on medical background to create and oversee clinical strategy for the region. The Regional VP of Health Services serves as the senior clinical executive responsible for shaping and executing the region’s clinical engagement strategy, driving quality improvement, cost efficiency, and population health outcomes through strategic provider partnerships, data-informed decision-making, and cross-functional collaboration. The RVP acts as a key advisor, innovator, and relationship builder, ensuring alignment with Humana’s mission and Medicare Advantage goals. Base pay range:
$298,000.00/yr - $409,800.00/yr . Primary Responsibilities
Clinical Engagement & Provider Strategy:
Cultivate and maintain trusted relationships with CMOs and senior executive/clinical leaders at provider and care delivery partner organizations; build relationships with providers to drive performance, remove operational barriers, and reduce administrative burden. Lead clinical executive for provider groups, translating clinical and quality priorities into actionable strategies; promote growth and innovation with provider groups, particularly CenterWell partners. Enhance hospital-system innovation while fostering collaboration and reducing barriers. Drive population health initiatives to improve member health and well-being, including: understanding clinical metrics and data (Quality measures, Risk Adjustment, chronic condition management, PCP visit rates and effectiveness, member engagement); identifying and implementing total cost of care initiatives; championing condition-based interventions; leading clinical strategies for unique populations (e.g., unattributed members, low income, disabled, or special needs). Clinical Strategy & Market Performance
Serve as clinical steward for regional medical expense trends; use data to guide interventions and ensure fiscal accountability. Collaborate with finance, analytics, and market leadership to identify cost and quality outliers and implement targeted actions. Customize strategies to align clinical programs with MA, D-SNP payer needs. Provide clinical input into network development, contract negotiations, and delegation oversight. Represent Humana in regional health coalitions and community health initiatives; collaborate with centralized utilization management 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 technologies and care models (e.g., remote monitoring, clinical pathways, tech-enabled care). Lead regional implementation of clinical programs; evaluate performance against clinical and financial KPIs. Collaborate with vendor partnerships; participate in governance committees and delegation oversight as needed. Qualifications
Active MD or DO licensure with appropriate training and certification 5+ years clinical practice 5+ years in managed care industry (provider or payer) Strong knowledge of healthcare utilization, quality metrics, and value-based contracting impact on provider behavior Ability to monitor clinical metrics and communicate impact clearly Excellent communication skills; ability to convey complex material to diverse audiences Strategic thinker with ability to balance long-term vision and execution Proven track record of building successful teams and cross-departmental relationships Travel required 25%-30% Reside within the region’s geographic boundaries Preferred
Experience in both provider and payer roles Executive-level experience with external relationship building and driving quality and financial results in a collaborative environment Advanced degree in business, management, and/or population health Additional Details
Travel: Remote position with occasional travel to Humana offices for training or meetings may be required. Scheduled Weekly Hours: 40 Pay Range:
$298,000 - $409,800 per year This job is eligible for a bonus incentive plan based on company and/or individual performance. Description Of Benefits: Humana offers competitive benefits including medical, dental and vision, 401(k), paid time off, holidays, and more. About Us: Humana is committed to putting health first and delivering care and service when people need it. Equal Opportunity Employer: Humana does not discriminate on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. We comply with applicable laws and promote affirmative action where required. Senior/Other
Seniority level: Executive Employment type: Full-time Job function: Business Development and Sales Industries: Insurance
#J-18808-Ljbffr
Join to apply for the
Regional VP, Health Services - Midwest Region
role at
Humana . Overview
The Regional VP, Health Services relies on medical background to create and oversee clinical strategy for the region. The Regional VP of Health Services serves as the senior clinical executive responsible for shaping and executing the region’s clinical engagement strategy, driving quality improvement, cost efficiency, and population health outcomes through strategic provider partnerships, data-informed decision-making, and cross-functional collaboration. The RVP acts as a key advisor, innovator, and relationship builder, ensuring alignment with Humana’s mission and Medicare Advantage goals. Base pay range:
$298,000.00/yr - $409,800.00/yr . Primary Responsibilities
Clinical Engagement & Provider Strategy:
Cultivate and maintain trusted relationships with CMOs and senior executive/clinical leaders at provider and care delivery partner organizations; build relationships with providers to drive performance, remove operational barriers, and reduce administrative burden. Lead clinical executive for provider groups, translating clinical and quality priorities into actionable strategies; promote growth and innovation with provider groups, particularly CenterWell partners. Enhance hospital-system innovation while fostering collaboration and reducing barriers. Drive population health initiatives to improve member health and well-being, including: understanding clinical metrics and data (Quality measures, Risk Adjustment, chronic condition management, PCP visit rates and effectiveness, member engagement); identifying and implementing total cost of care initiatives; championing condition-based interventions; leading clinical strategies for unique populations (e.g., unattributed members, low income, disabled, or special needs). Clinical Strategy & Market Performance
Serve as clinical steward for regional medical expense trends; use data to guide interventions and ensure fiscal accountability. Collaborate with finance, analytics, and market leadership to identify cost and quality outliers and implement targeted actions. Customize strategies to align clinical programs with MA, D-SNP payer needs. Provide clinical input into network development, contract negotiations, and delegation oversight. Represent Humana in regional health coalitions and community health initiatives; collaborate with centralized utilization management 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 technologies and care models (e.g., remote monitoring, clinical pathways, tech-enabled care). Lead regional implementation of clinical programs; evaluate performance against clinical and financial KPIs. Collaborate with vendor partnerships; participate in governance committees and delegation oversight as needed. Qualifications
Active MD or DO licensure with appropriate training and certification 5+ years clinical practice 5+ years in managed care industry (provider or payer) Strong knowledge of healthcare utilization, quality metrics, and value-based contracting impact on provider behavior Ability to monitor clinical metrics and communicate impact clearly Excellent communication skills; ability to convey complex material to diverse audiences Strategic thinker with ability to balance long-term vision and execution Proven track record of building successful teams and cross-departmental relationships Travel required 25%-30% Reside within the region’s geographic boundaries Preferred
Experience in both provider and payer roles Executive-level experience with external relationship building and driving quality and financial results in a collaborative environment Advanced degree in business, management, and/or population health Additional Details
Travel: Remote position with occasional travel to Humana offices for training or meetings may be required. Scheduled Weekly Hours: 40 Pay Range:
$298,000 - $409,800 per year This job is eligible for a bonus incentive plan based on company and/or individual performance. Description Of Benefits: Humana offers competitive benefits including medical, dental and vision, 401(k), paid time off, holidays, and more. About Us: Humana is committed to putting health first and delivering care and service when people need it. Equal Opportunity Employer: Humana does not discriminate on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. We comply with applicable laws and promote affirmative action where required. Senior/Other
Seniority level: Executive Employment type: Full-time Job function: Business Development and Sales Industries: Insurance
#J-18808-Ljbffr