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.
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.
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.
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.
Active MD or DO licensure with appropriate training and certification
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
Reside within the region’s geographic boundaries
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.
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.$298,000 - $409,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.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.
Originally posted on Himalayas
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