Regional VP, Health Services
New
H
HumanaMedicaid managed care
Source API remote eligibility restrictions: United StatesFull-TimeVp
Salary$327,700 - $450,600 per year
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Job Details
- Experience
- 10+ years of progressive clinical and healthcare leadership experience
Requirements
- Hold an M.D. or D.O. degree.
- Have a current, unrestricted medical license and board certification, with the ability to practice in Indiana.
- Bring 10+ years of progressive clinical and healthcare leadership experience.
- Have experience in managed care, Medicaid, Medicare, or value-based care environments.
- Have a record of leading utilization management, care management, quality improvement, population health, and medical cost management strategies.
- Demonstrate the ability to influence executive leaders, state partners, and cross-functional teams.
- Have experience partnering with providers, health systems, community organizations, and government stakeholders.
- Bring strategic, financial, and executive leadership skills in a complex matrix organization.
- Have experience working directly with state Medicaid agencies, CMS, accreditation organizations, and regulatory oversight entities.
- Preferred: experience as a senior clinical leader for a Medicaid managed care organization, integrated care program, MLTSS program, D-SNP, FIDE-SNP, or another Medicare-Medicaid integrated model.
- Preferred: medical management experience with health insurance organizations, hospitals, healthcare providers, or patient interaction.
- Preferred: Internal Medicine, Family Practice, Geriatrics, Hospitalist, ER, or PM&R clinical specialty.
- Preferred: Master's degree.
Responsibilities
- Provide medical leadership and clinical strategy for Indiana Medicaid lines of business, including integrated Medicare-Medicaid products.
- Support business development through procurement strategy, stakeholder engagement, competitive positioning, and clinical solutions.
- Collaborate with internal and external stakeholders to implement strategic initiatives and achieve business results.
- Oversee utilization management, care management, quality operations, and medical necessity strategies.
- Lead clinical strategy, performance, compliance, and operational effectiveness of care management programs.
- Lead market-level clinical programs and quality improvement initiatives, including HEDIS/STARS performance, peer review, and Quality Management Committee governance.
- Partner with providers, facilities, and ancillary networks on relationships, contracting activities, and value-based and risk-sharing arrangements.
- Manage medical cost strategy and fiscal responsibility for trend management.
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