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Regional VP, Health Services

Humana

Humana

Georgia, USA · Remote
Posted on Monday, September 25, 2023

Description

The Regional VP, Health Services serves as the Chief Medical Officer of the region, with responsibility for clinical operations and strategy.

Responsibilities

The Regional VP, Health Services provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Decisions are typically related to intradepartmental coordination, development and implementation of strategic plans, and business outcomes, and develops and implements strategic plans for the scope of management that are aligned with the Segment or Business strategy.

  • Oversees utilization management for acute care hospital, long-term acute hospital, acute rehabilitation, and skilled nursing admissions.
  • Identifies medical cost trends and strategies.
  • Informs and defines clinical policy.
  • Collaborates in identification and implementation of clinical programs and strategies to manage unique populations.
  • Oversees vended clinical solutions.
  • Consults with provider contracting in development of the provider network.
  • Manages clinical relationships with health systems and value-based providers.

Required Qualifications

  • 5 years of established clinical experience.
  • Current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment.
  • MD or DO degree.
  • Board Certified in an approved ABMS Medical Specialty.
  • Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products.
  • Prior utilization management experience.
  • Excellent communication skills.
  • Must be passionate about the consumer experience.
  • Highly collaborative and able to thrive in a highly matrix environment.

Preferred Qualifications

  • Medical management experience, working with health insurance organizations, hospitals and other healthcare providers.
  • Versed in value-based care with an ability to overcome objections and gain adoption with providers.
  • Internal Medicine, Family Practice, Geriatrics, Hospitalists.

Scheduled Weekly Hours

40