Humana

Director, Health Services--South Central Region

Texas, United States

Not SpecifiedCompensation
Expert & Leadership (9+ years)Experience Level
Full TimeJob Type
UnknownVisa
Health Services, HealthcareIndustries

Clinical Director - South Central Region (Texas, Oklahoma and Arkansas)

Employment Type: Full-time

Position Overview

Become a part of our caring community and help us put health first. The Clinical Director is a key member of the regional clinical leadership team responsible for executing market-level clinical strategy, supporting provider performance, and coordinating with cross-functional teams to drive quality, utilization, and cost-of-care outcomes. At the core, this is a role focused on building relationships with providers and then leveraging those relationships to collaborate on how to overcome operational barriers, reduce administrative burden, and optimize clinical strategies for the benefit of our members.

Responsibilities

Clinical Strategy Execution & Provider Engagement

  • Partner with provider leadership by:
    • Developing and maintaining strong relationships with provider group leaders, ensuring timely communication, education, and collaboration.
    • Strengthening relationships, enhancing clinical performance, and driving improvements in patient experience and operational excellence.
    • Aligning on strategic goals, sharing best practices, and collaborating on initiatives that support quality care delivery and system-wide performance.
  • Contribute to the design and operationalization of the region’s clinical strategy by:
    • Driving clinical initiatives across the provider network.
    • Supporting facility and provider population health programs focused on Stars, HEDIS, MRA, chronic condition management, and other efforts to reduce avoidable utilization.
    • Supporting Joint Operating Committees (JOCs) and facilitating implementation with pilots around reducing cost of care and improving chronic health care outcomes.

Data-Driven Performance Management

  • Working closely with analytics and finance teams, the Clinical Director will:
    • Monitor key performance indicators, identify trends in quality and utilization, and support the development of targeted action plans.
    • Prepare performance dashboards, conduct root cause analyses, and facilitate provider education and remediation efforts.
    • Collaborate with hospital partners to align on shared performance goals, support data transparency, and drive improvements in clinical outcomes, patient experience, and operational efficiency.
    • Partner with the Regional VP of Health Services to align clinical programs with payer-specific needs and market dynamics.

Innovation & Program Implementation

  • Implement regional pilots and vendor-supported programs, ensuring operational readiness and provider adoption. This includes:
    • Advancing the rollout of remote monitoring tools, clinical pathway platforms, and other tech-enabled care solutions.
    • Working with hospital teams to integrate innovative solutions into inpatient and transitional care workflows, tracking program performance, escalating barriers to adoption, and contributing to continuous improvement efforts that enhance both provider and patient experience.

Governance & Delegation Oversight

  • Participate in governance committees and support vendor and delegation oversight activities, including:
    • Ensuring compliance with clinical policies, quality standards, and regulatory requirements.
    • Collaborating with hospital leadership to align governance practices.
    • Promoting operational excellence across delegated entities and facility-based care settings.

Qualifications

  • Clinical degree with active unrestricted license (e.g., RN, NP).
  • 5+ years of experience in clinical operations, care management, or provider performance improvement.
  • 5+ years of experience in the managed care industry, either provider or payer.
  • Strong understanding of value-based care, population health, and quality metrics (e.g., Stars, HEDIS, MRA).
  • Proficiency in quickly monitoring clinical performance indicators.

Company Information

Use your skills to make an impact.

Skills

Clinical Strategy
Provider Engagement
Population Health
Stars
HEDIS
MRA
Chronic Condition 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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