Humana
Overview
Regional VP, Health Services - Midwest Region Humana is seeking a Regional VP, Health Services to create and oversee clinical strategy for the region. The role requires an in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide, and the ability to translate clinical priorities into actionable strategies that drive quality improvement, cost efficiency, and population health outcomes. Responsibilities
Cultivate and maintain trusted relationships with CMOs and senior executive/clinical leaders at provider and care delivery partner organizations. This role focuses on building provider relationships and leveraging them to 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, promoting growth and innovation with all provider groups, particularly CenterWell partners. Enhance innovation with hospital systems while fostering collaboration and reducing operational barriers. Drive population health initiatives to improve member health outcomes, including: Understand clinical metrics and data (Quality measures, Risk Adjustment, chronic condition management, PCP visit rates and effectiveness, member engagement strategies). Identify and implement initiatives to address total cost of care drivers. Champion condition-based interventions. Lead clinical strategies to manage unique populations (unattributed membership, low income, disabled, or special needs members). Clinical Strategy & Market Performance: Serve as the clinical steward for regional medical expense trends, using 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 MA, D-SNP payer-specific needs. Provide clinical input into network development, contract negotiations, and delegation oversight. Serve as clinical subject matter expert for plan design and clinical programs to support health plan growth. Represent the organization in regional health coalitions and community health initiatives. Collaborate with 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 clinically focused strategic programs. Collaborate with vendor partnerships and evaluate performance against clinical and financial KPIs. May be involved 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 the impact of value-based contracting on provider behavior and performance Ability to monitor clinical metrics quickly and convey impact verbally and in writing Proficient communication skills (interpersonal, written, presentation) and ability to explain 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 the region’s geographic boundaries Preferred
Experience in both provider and payer roles Prior executive-level role with success in building external relationships and driving quality and financial results in a collaborative environment Advanced degree in business, management and/or population health Other 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 range reflects a good faith estimate of starting base pay for full-time employment at posting time and may vary by location and individual qualifications. Eligible for a bonus incentive plan. Description of Benefits: Humana offers medical, dental, and vision benefits, 401(k), paid time off and holidays, disability coverage, life insurance, and other opportunities. About Us & EEO
Humana is committed to putting health first for teammates, customers, and the company, with efforts across Medicare, Medicaid, and community health efforts. Humana is an Equal Opportunity Employer and 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. We also support affirmative action in compliance with applicable laws.
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Regional VP, Health Services - Midwest Region Humana is seeking a Regional VP, Health Services to create and oversee clinical strategy for the region. The role requires an in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide, and the ability to translate clinical priorities into actionable strategies that drive quality improvement, cost efficiency, and population health outcomes. Responsibilities
Cultivate and maintain trusted relationships with CMOs and senior executive/clinical leaders at provider and care delivery partner organizations. This role focuses on building provider relationships and leveraging them to 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, promoting growth and innovation with all provider groups, particularly CenterWell partners. Enhance innovation with hospital systems while fostering collaboration and reducing operational barriers. Drive population health initiatives to improve member health outcomes, including: Understand clinical metrics and data (Quality measures, Risk Adjustment, chronic condition management, PCP visit rates and effectiveness, member engagement strategies). Identify and implement initiatives to address total cost of care drivers. Champion condition-based interventions. Lead clinical strategies to manage unique populations (unattributed membership, low income, disabled, or special needs members). Clinical Strategy & Market Performance: Serve as the clinical steward for regional medical expense trends, using 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 MA, D-SNP payer-specific needs. Provide clinical input into network development, contract negotiations, and delegation oversight. Serve as clinical subject matter expert for plan design and clinical programs to support health plan growth. Represent the organization in regional health coalitions and community health initiatives. Collaborate with 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 clinically focused strategic programs. Collaborate with vendor partnerships and evaluate performance against clinical and financial KPIs. May be involved 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 the impact of value-based contracting on provider behavior and performance Ability to monitor clinical metrics quickly and convey impact verbally and in writing Proficient communication skills (interpersonal, written, presentation) and ability to explain 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 the region’s geographic boundaries Preferred
Experience in both provider and payer roles Prior executive-level role with success in building external relationships and driving quality and financial results in a collaborative environment Advanced degree in business, management and/or population health Other 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 range reflects a good faith estimate of starting base pay for full-time employment at posting time and may vary by location and individual qualifications. Eligible for a bonus incentive plan. Description of Benefits: Humana offers medical, dental, and vision benefits, 401(k), paid time off and holidays, disability coverage, life insurance, and other opportunities. About Us & EEO
Humana is committed to putting health first for teammates, customers, and the company, with efforts across Medicare, Medicaid, and community health efforts. Humana is an Equal Opportunity Employer and 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. We also support affirmative action in compliance with applicable laws.
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