Director, Health Services--Pacific Southwest Region

California, 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, such as RN or NP. A minimum of 5 years of experience in clinical operations, care management, or provider performance improvement is required, along with 5+ years of experience in the managed care industry (provider or payer). A strong understanding of value-based care, population health, and quality metrics like Stars, HEDIS, and MRA is essential, as is proficiency in monitoring clinical and financial data and communicating insights.

Responsibilities

The Director, Health Services will execute market-level clinical strategy and support provider performance by developing and maintaining strong relationships with provider leadership. They will drive clinical initiatives, support population health programs focused on quality metrics, and collaborate on efforts to reduce the cost of care and improve chronic health outcomes. This role involves monitoring key performance indicators, identifying trends, developing action plans, and facilitating provider education. The Director will also implement regional pilots and tech-enabled care solutions, ensuring provider adoption and integrating innovative solutions into workflows. Additionally, they will participate in governance committees, support vendor oversight, and ensure compliance with clinical policies and regulatory requirements.

Skills

Clinical Strategy

Provider Engagement

Population Health

Quality Improvement

Utilization Management

Cost of Care Management

Performance Management

Data Analysis

Relationship Building

Communication

Collaboration

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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