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Humana

Regional VP, Health Services - Midwest Region

Humana, Lansing, Michigan, United States

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Regional VP, Health Services - Midwest Region

3 days ago Be among the first 25 applicants Get AI-powered advice on this job and more exclusive features. 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 requires an in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide. The Regional VP of Health Services, Humana Medicare Advantage, 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. 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 and leverage them to improve provider performance, reduce administrative burden, and overcome operational barriers. Serve as 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 innovation with hospital systems, fostering collaboration and reducing operational barriers. Drive population health initiatives to improve member health outcomes, including: Metrics and data understanding (e.g., Quality measures, Risk Adjustment, chronic condition management, PCP visit rates, member engagement). Identify and implement initiatives to address total cost of care drivers. Champion condition-based interventions. Lead clinical strategies for unique populations (unattributed members, low income, disabled, or special needs members). Clinical Strategy & Market Performance: serve as the 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 action plans. Customize strategies to align clinical programs with payer-specific 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 resolution. Innovation & Transformation: partner with national innovation teams to pilot and scale emerging technologies and care models; 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 communicate impact verbally and in writing Proficient communication skills (interpersonal, written, and presentation) and ability to simplify complex material for action 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% Reside within the 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 team/matrixed environment Advanced degree in business, management and/or population health Travel

Travel: While this is a remote position, occasional travel to Humana offices for training or meetings may be required. Compensation & Schedule

Scheduled Weekly Hours : 40 Pay Range : $298,000 - $409,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Benefits & About Us

Description Of Benefits : Humana offers medical, dental and vision benefits, 401(k) retirement savings, 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 the company, delivering care and service when needed. Through Humana insurance services and CenterWell healthcare services, we aim to improve quality of life for people across Medicare, Medicaid, families, individuals, military personnel, and communities. Equal Opportunity Employer

Humana does not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or protected veteran status. Humana commits to affirmative action in compliance with Section 503 of the Rehabilitation Act and VEVRAA. Job Details

Seniority level: Executive Employment type: Full-time Job function: Business Development and Sales Industries: Insurance Referrals increase your chances of interviewing at Humana. Get notified about new Vice President of Services jobs in Michigan, United States.

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