Director, Health Services--Midwest Region

Kentucky, United States

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Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Services, HealthcareIndustries

Requirements

Candidates must possess a clinical degree with an active, unrestricted license (e.g., RN, NP). A minimum of 5 years of experience in clinical operations, care management, or provider performance improvement is required, along with 5+ years in the managed care industry (provider or payer). A strong understanding of value-based care, population health, and quality metrics such as Stars, HEDIS, and MRA is essential, as is proficiency in monitoring clinical and financial data to drive decisions.

Responsibilities

The Director, Health Services will execute the regional clinical strategy, support provider performance, and collaborate with cross-functional teams to improve quality, utilization, and cost-of-care outcomes. Responsibilities include building and maintaining strong relationships with provider leadership, driving clinical initiatives, supporting population health programs, and analyzing key performance indicators to develop action plans. The role also involves implementing regional pilots and tech-enabled care solutions, participating in governance committees, and ensuring compliance with clinical policies and regulatory requirements.

Skills

Clinical Strategy

Provider Engagement

Relationship Building

Performance Management

Quality Improvement

Utilization Management

Cost of Care Optimization

Population Health

Chronic Condition Management

Data Analysis

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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