[Remote] Director of Health Services--Pacific Southwest Region at Humana

California, United States

Apply Now

Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

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 experience in 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 and financial data and communicating it to drive decision-making

Responsibilities

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
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
Monitoring key performance indicators, identify trends in quality and utilization, and support the development of targeted action plans
Preparing performance dashboards, conduct root cause analyses, and facilitate provider education and remediation efforts
Collaborating with hospital partners to align on shared performance goals, support data transparency, and drive improvements in clinical outcomes, patient experience, and operational efficiency
Partnering with the Regional VP of Health Services to align clinical programs with payer-specific needs and market dynamics
Implementing regional pilots and vendor-supported programs, ensuring operational readiness and provider adoption
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
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

Skills

Clinical Strategy

Provider Engagement

Relationship Building

Data Analysis

Performance Management

Population Health

Quality Improvement

Chronic Condition Management

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.

Land your dream remote job 3x faster with AI

Try Jobo Free