Regional VP - Health Services

October 12

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Humana

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10,000+

Description

• Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTAC, Acute rehab, SNF) 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. Use your skills to make an impact

Requirements

• 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 • MD or DO degree • 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

Benefits

• 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 • many other opportunities