Regional VP, Health Services - Medicaid

Humana • Louisville, KY

1d • Hybrid

About The Position

The Regional VP, Health Services relies on medical background to create and oversee clinical strategy for the region. The Regional VP, Health Services requires an in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide. The Regional VP, Health Services will provide medical leadership and strategy for the Health Services Operations with fiscal responsibility for trend management.

Requirements

• MD or DO degree
• 8 or more years of management experience
• A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment
• Board Certified in an approved ABMS Medical Specialty
• Excellent communication skills
• 5 years of established clinical experience
• Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products
• Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• Candidates must hold or be willing to obtain a valid Kentucky medical license and reside or be willing to relocate to Kentucky.

Nice To Haves

• Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.
• Internal Medicine, Family Practice, Geriatrics, Hospitalist, ER, PM&R clinical specialists
• Master's Degree

Responsibilities

• Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTAC, Acute rehab, SNF) according to the Humana Medicare Model of Care.
• Participate in Quality Operations including chair Quality Management Committee, complete initial peer review on quality of care complaints, complete peer-to-peer written and verbal communications.
• Oversee administrative budget for regional HSO & Quality Improvement including approve/deny expense reports & requisition requests for department members.
• Oversee Quality Improvement and HEDIS/STARS metrics improvement with PCP offices and IPAs.
• Participate in regional level committees and meetings setting medical necessity strategies.
• Provide oversight and direction for the implementation of regional clinical programs and strategies, as well as, developing and implementing market level strategies.
• Manage internal operational/functional relationships related to profitability.
• Assist with network development and provider contracting with various providers and ancillary providers.
• Serve as clinical liaison with inpatient facilities and joint operating committees to maintain facility relationship and problem solve; especially reviewing contracts as to clinical services.
• Well-versed on financial aspects of various levels of risk bearing contracts and possess the ability to gain traction and adoption of the providers.
• Ability to thrive in a highly matrix environment.

Benefits

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Ph.D. or professional degree
• Number of Employees: 5,001-10,000 employees