Regional VP, Health Services

Humana • Work at Home - Indiana, IN

3d • $327,700 - $450,600 • Remote

About The Position

The Medicaid Chief Medical Officer for Indiana provides market-based medical leadership and clinical strategy for Humana Healthy Horizons in Indiana. This leader oversees clinical operations, quality, utilization management, population health, and medical cost strategy while serving as a senior clinical representative with the State, providers, community partners, and other key stakeholders. Provides strategic and operational clinical leadership for all Indiana Medicaid lines of business, including Medicaid-only, Medicaid LTSS, and integrated Medicare-Medicaid products, including integrated D-SNP, as applicable. The role also contributes to Indiana Medicaid business development by supporting procurement strategy, external relationship development, provider partnership opportunities, and differentiated clinical solutions that advance Humana’s growth, competitiveness, and long-term success in the state.
The Regional VP, Health Services will provide medical leadership and strategy for the Health Services Operations with fiscal responsibility for trend management.
Support all Indiana Medicaid lines of business, including integrated D-SNP business development activities, including procurement strategy, stakeholder engagement, competitive market positioning, and the development of innovative clinical solutions that drive growth and strengthen Humana's presence in the state.
Serve as a key clinical leader in a highly matrixed environment, collaborating across internal and external stakeholders to implement strategic initiatives and achieve business results.
Provide medical leadership and oversight of utilization management, care management, quality operations, and medical necessity strategies to ensure high-quality, cost-effective care delivery.
Oversees the clinical strategy, performance, compliance, and operational effectiveness of care management programs, ensuring alignment with state contract requirements, member needs, quality outcomes, utilization management priorities, and integrated model objectives.
Lead market-level clinical programs and quality improvement initiatives, including HEDIS/STARS performance, peer review activities, and Quality Management Committee governance.
Partner with providers, facilities, and ancillary networks to strengthen relationships, support contracting activities, and drive adoption of value-based and risk-sharing arrangements.

Requirements

• M.D. or D.O. degree with current, unrestricted medical license and board certification, with the ability to practice in Indiana.
• 10+ years of progressive clinical and healthcare leadership experience, including managed care, Medicaid, Medicare, or value-based care environments.
• Experience serving as the senior clinical leader for a Medicaid managed care organization, integrated care program, MLTSS program, D-SNP, FIDE-SNP, or other Medicare-Medicaid integrated model is preferred.
• Proven experience leading utilization management, care management, quality improvement, population health, and medical cost management strategies.
• Proven ability to influence executive leaders, state partners, and cross-functional teams to achieve clinical, operational, quality, and compliance objectives.
• Demonstrated success partnering with providers, health systems, community organizations, and government stakeholders to improve healthcare outcomes and drive business results.
• Strong strategic, financial, and executive leadership skills, with the ability to influence in a complex matrix organization and support growth, network, and procurement initiatives.
• Experience working directly with state Medicaid agencies, CMS, accreditation organizations, and regulatory oversight entities.

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

• Provide medical leadership and strategy for the Health Services Operations with fiscal responsibility for trend management.
• Support all Indiana Medicaid lines of business, including integrated D-SNP business development activities, including procurement strategy, stakeholder engagement, competitive market positioning, and the development of innovative clinical solutions that drive growth and strengthen Humana's presence in the state.
• Serve as a key clinical leader in a highly matrixed environment, collaborating across internal and external stakeholders to implement strategic initiatives and achieve business results.
• Provide medical leadership and oversight of utilization management, care management, quality operations, and medical necessity strategies to ensure high-quality, cost-effective care delivery.
• Oversee the clinical strategy, performance, compliance, and operational effectiveness of care management programs, ensuring alignment with state contract requirements, member needs, quality outcomes, utilization management priorities, and integrated model objectives.
• Lead market-level clinical programs and quality improvement initiatives, including HEDIS/STARS performance, peer review activities, and Quality Management Committee governance.
• Partner with providers, facilities, and ancillary networks to strengthen relationships, support contracting activities, and drive adoption of value-based and risk-sharing arrangements.

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Ph.D. or professional degree