Become a part of our caring community and help us put health first
The Regional VP, Health Services will provide medical leadership and strategy for the Health Services Operations, which includes: Care Management for D-SNP, BadgerCare+, and SSI contracts; Quality and Population Health functions; Prior Auth and Utilization Mgmt; and Pharmacy. Has fiscal responsibility for trend management across all medical and pharmacy related cost drivers.
The Regional VP, Health Services will provide medical leadership and strategy for the Health Services Operations, which includes: Care Management for D-SNP, BadgerCare+, and SSI contracts; Quality and Population Health functions; Prior Auth and Utilization Mgmt; and Pharmacy. Has fiscal responsibility for trend management across all medical and pharmacy related cost drivers.
•Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTAC, Acute rehab, SNF, Pharmacy, and MLTSS) according to the Humana Medicaid and Medicare Model of Care.
•Participate in Quality/Population Health 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, Population Health, Pharmacy and Care Management 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 and partner across shared service and support functions.
•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
•8 or more years of management experience
•Must live in Wisconsin and have a current/unrestricted medical license and willing to obtain license, as required, for various states in region of assignment.
•MD or DO degree
•Excellent communication skills
•5 years of established clinical experience
•Knowledge of the managed care industry including Medicare, Medicaid and or MLTSS 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
•Board Certified in an approved ABMS Medical Specialty
•Master's Degree
#PhysicianCareers
Use your skills to make an impact
Required Qualifications
•8 or more years of management experience
•Must live in Wisconsin and have a current/unrestricted medical license and willing to obtain license, as required, for various states in region of assignment.
•MD or DO degree
•Excellent communication skills
•5 years of established clinical experience
•Knowledge of the managed care industry including Medicare, Medicaid and or MLTSS 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
•Board Certified in an approved ABMS Medical Specialty
•Master's Degree
#PhysicianCareers
Scheduled Weekly Hours
40
Pay 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.
$265,500 - $365,200 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
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 veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.
