The Regional VP, Health Services will provide medical leadership and strategy for the Health Services Operations with fiscal responsibility for trend management.
•Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTAC, Acute rehab, SNF), LTSS services, 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.
Required Qualifications
•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
Preferred Qualifications
•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
20% Travel in Michigan and Corporate office in Kentucky.
•Master's Degree
#PhysicianCareers
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and 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 and many other opportunities.
Equal Opportunity Employer
It is the policy of Humana not to 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. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
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Salem Township, Michigan, United States
Remote only
