Regional VP, Health Services

Humana • Miami, FL

8d • Remote

About The Position

Become a part of our caring community and help us put health first As the Regional VP of Health Services, you will serve as the senior clinical executive responsible for shaping and executing the region’s clinical engagement strategy. This role drives 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.

Requirements

• Active MD or DO licensure with appropriate training and certification
• 5+ years clinical practice
• 5 + years in managed care industry, either provider or payer.
• Thorough knowledge of health care utilization and quality metrics and the impact value-based contracting has on provider behavior and performance.
• The ability to quickly monitor clinical metrics and convey the impact verbally and in writing.
• Proficient communication skills, including interpersonal, written and presentation, and the ability to promote complex material in a way that can be understood and acted upon by others.
• Strategic thinker with the ability to balance long-term vision and short-term execution.
• Established track record of building successful teams and cross departmental relationships
• Travel required 30-35%
• Reside within the region’s geographic boundaries

Nice To Haves

• Experience in both provider and payer roles
• Prior executive level role with successful 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.

Responsibilities

• Clinical Engagement & Provider Strategy: Cultivate and maintain trusted relationships with CMOs and senior executive/clinical leaders at provider and care delivery partner organizations. First and foremost, this is a role focused on building relationships with providers, and then leveraging those relationships to collaborate on how to positively 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. This includes promoting growth strategies and innovation with all provider groups, particularly our CenterWell partners.
• Enhance innovation with hospital systems while fostering collaboration and reducing operational barriers.
• Drive population health initiatives to improve the health and well-being of our members including: A strong understanding of clinical metrics and data (e.g. Quality measures, Risk Adjustment ratings, chronic condition management, PCP visit rates and effectiveness, and member engagement strategies).
• Identifying and implementing initiatives to address total cost of care drivers.
• Championing condition-based interventions.
• Leading clinical strategies to manage unique populations, such as unattributed membership, low income, disabled, or special needs members.
• Clinical Strategy & Market Performance: Serve as the clinical steward for regional medical expense trends, leveraging 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.
• Serve as clinical subject matter for potential plan design and clinical programs to support continued health plan growth.
• Represent the organization in regional health coalitions and community health initiatives.
• Collaborate with various 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 clinical focused strategic programs.
• Collaborate with vendor partnerships and evaluate performance against clinical and financial KPIs.
• May also be involved in governance committees and delegation oversight.

Benefits

• Humana provides 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 and many other opportunities.

What This Job Offers

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