Humana
Regional VP, Health Services - Midwest Region
Humana, Virginia, Minnesota, United States, 55792
Overview
Regional VP, Health Services - Midwest Region Base pay range: $298,000.00/yr - $409,800.00/yr. Pay range, eligibility for bonus, and company information discussed with recruiter. Responsibilities
Serve as the senior clinical executive responsible for shaping and executing the region’s clinical engagement strategy. Drive quality improvement, cost efficiency, and population health outcomes through strategic provider partnerships, data-informed decision-making, and cross-functional collaboration. Act as a key advisor, innovator, and relationship builder, ensuring alignment with Humana’s mission and Medicare Advantage goals. Clinical Engagement & Provider Strategy: cultivate and maintain trusted relationships with CMOs and senior executive/clinical leaders at provider and care delivery partner organizations; translate clinical and quality priorities into actionable strategies; promote growth and innovation with provider groups, particularly CenterWell partners. Enhance innovation with hospital systems, foster collaboration, and reduce operational barriers. Drive population health initiatives, including a strong understanding of clinical metrics and data, identifying and implementing initiatives to reduce total cost of care, championing condition-based interventions, and leading strategies to manage unique populations (e.g., unattributed membership, low income, disabled, or special needs members). Clinical Strategy & Market Performance: serve as the clinical steward for regional medical expense trends; collaborate with finance, analytics, and market leadership to identify cost and quality outliers and implement targeted action plans; customize strategies to payer needs (MA, D-SNP); provide clinical input into network development, contract negotiations, and delegation oversight; represent the organization 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 processes. Innovation & Transformation: partner with national innovation teams to pilot and scale emerging technologies and care models; lead regional implementation of clinical programs; collaborate with vendor partnerships and evaluate performance against clinical and financial KPIs; may participate in governance committees and delegation oversight. Qualifications
Active MD or DO licensure with appropriate training and certification 5+ years clinical practice 5+ years in managed care industry (provider or payer) Thorough knowledge of health care utilization and quality metrics and value-based contracting impact on provider behavior and performance Ability to monitor clinical metrics quickly and convey impact verbally and in writing Proficient communication skills (interpersonal, written and presentation) and ability to promote complex material clearly Strategic thinker with 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% Residence within region’s geographic boundaries Preferred
Experience in both provider and payer roles Prior executive-level role with track record of building external relationships and driving quality and financial results in a collaborative environment Advanced degree in business, management and/or population health Travel
Remote position with occasional travel to Humana offices for training or meetings may be required. Hours & Pay
Scheduled Weekly Hours: 40 Pay Range: $298,000 - $409,800 per year. This job is eligible for a bonus incentive plan dependent on company and individual performance. Benefits
Humana offers competitive benefits including medical, dental, vision, 401(k), paid time off, holidays, volunteer time off, parental and caregiver leave, disability coverage, life insurance, and other opportunities. About Us
Humana Inc. (NYSE: HUM) is committed to putting health first – for teammates, customers and company. Through Humana and CenterWell, we aim to help people achieve their best health and quality of life. Equal Opportunity Employer
Humana does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. Humana complies with Section 503 of the Rehabilitation Act and VEVRAA in employment decisions and provides equal opportunity in all aspects of employment.
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Regional VP, Health Services - Midwest Region Base pay range: $298,000.00/yr - $409,800.00/yr. Pay range, eligibility for bonus, and company information discussed with recruiter. Responsibilities
Serve as the senior clinical executive responsible for shaping and executing the region’s clinical engagement strategy. Drive quality improvement, cost efficiency, and population health outcomes through strategic provider partnerships, data-informed decision-making, and cross-functional collaboration. Act as a key advisor, innovator, and relationship builder, ensuring alignment with Humana’s mission and Medicare Advantage goals. Clinical Engagement & Provider Strategy: cultivate and maintain trusted relationships with CMOs and senior executive/clinical leaders at provider and care delivery partner organizations; translate clinical and quality priorities into actionable strategies; promote growth and innovation with provider groups, particularly CenterWell partners. Enhance innovation with hospital systems, foster collaboration, and reduce operational barriers. Drive population health initiatives, including a strong understanding of clinical metrics and data, identifying and implementing initiatives to reduce total cost of care, championing condition-based interventions, and leading strategies to manage unique populations (e.g., unattributed membership, low income, disabled, or special needs members). Clinical Strategy & Market Performance: serve as the clinical steward for regional medical expense trends; collaborate with finance, analytics, and market leadership to identify cost and quality outliers and implement targeted action plans; customize strategies to payer needs (MA, D-SNP); provide clinical input into network development, contract negotiations, and delegation oversight; represent the organization 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 processes. Innovation & Transformation: partner with national innovation teams to pilot and scale emerging technologies and care models; lead regional implementation of clinical programs; collaborate with vendor partnerships and evaluate performance against clinical and financial KPIs; may participate in governance committees and delegation oversight. Qualifications
Active MD or DO licensure with appropriate training and certification 5+ years clinical practice 5+ years in managed care industry (provider or payer) Thorough knowledge of health care utilization and quality metrics and value-based contracting impact on provider behavior and performance Ability to monitor clinical metrics quickly and convey impact verbally and in writing Proficient communication skills (interpersonal, written and presentation) and ability to promote complex material clearly Strategic thinker with 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% Residence within region’s geographic boundaries Preferred
Experience in both provider and payer roles Prior executive-level role with track record of building external relationships and driving quality and financial results in a collaborative environment Advanced degree in business, management and/or population health Travel
Remote position with occasional travel to Humana offices for training or meetings may be required. Hours & Pay
Scheduled Weekly Hours: 40 Pay Range: $298,000 - $409,800 per year. This job is eligible for a bonus incentive plan dependent on company and individual performance. Benefits
Humana offers competitive benefits including medical, dental, vision, 401(k), paid time off, holidays, volunteer time off, parental and caregiver leave, disability coverage, life insurance, and other opportunities. About Us
Humana Inc. (NYSE: HUM) is committed to putting health first – for teammates, customers and company. Through Humana and CenterWell, we aim to help people achieve their best health and quality of life. Equal Opportunity Employer
Humana does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. Humana complies with Section 503 of the Rehabilitation Act and VEVRAA in employment decisions and provides equal opportunity in all aspects of employment.
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