Regional VP, Health Services - Humana Medicare Advantage

Employment Type: Full time

Position Overview

Become a part of our caring community and help us put health first. The Regional VP, Health Services relies on a medical background to create and oversee clinical strategy for the region. This role requires an in-depth understanding of how organizational capabilities interrelate across segments and/or enterprise-wide.

As the Regional VP of Health Services, you will serve as the senior clinical executive responsible for shaping and executing the region’s clinical engagement strategy. This role drives quality improvement, cost efficiency, and population health outcomes through strategic provider partnerships, data-informed decision-making, and cross-functional collaboration. The RVP acts as a key advisor, innovator, and relationship builder, ensuring alignment with Humana’s mission and Medicare Advantage goals.

Primary Responsibilities

Clinical Engagement & Provider Strategy:

• Cultivate and maintain trusted relationships with CMOs and senior executive/clinical leaders at provider and care delivery partner organizations.
• Focus on building relationships with providers to collaborate on positively driving provider performance, overcoming operational barriers, and reducing administrative burden.
• Serve as lead clinical executive for provider groups, translating clinical and quality priorities into actionable strategies.
• Promote growth strategies and innovation with all provider groups, particularly our CenterWell partners.
• Enhance innovation with hospital systems while fostering collaboration and reducing operational barriers.
• Drive population health initiatives to improve the health and well-being of our members, including:
  • A strong understanding of clinical metrics and data (e.g., Quality measures, Risk Adjustment ratings, chronic condition management, PCP visit rates and effectiveness, and member engagement strategies).
  • Identifying and implementing initiatives to address total cost of care drivers.
  • Championing condition-based interventions.
  • Leading clinical strategies to manage unique populations, such as unattributed membership, low income, disabled, or special needs members.

Clinical Strategy & Market Performance:

• Serve as the clinical steward for regional medical expense trends, leveraging data to guide interventions, and ensure fiscal accountability.
• Collaborate with finance, analytics, and market leadership to identify cost and quality outliers and implement targeted action plans.
• Customize strategies to align clinical programs with payer-specific needs (MA, D-SNP).
• Provide clinical input into network development, contract negotiations, and delegation oversight.
• Serve as clinical subject matter expert for potential plan design and clinical programs to support continued health plan growth.
• Represent the organization in regional health coalitions and community health initiatives.
• Collaborate with various operational functions in the centralized utilization management team and other shared services.
• Participate in quality governance, peer review, and grievance resolution processes.

Innovation & Transformation:

• Partner with national innovation teams to pilot and scale emerging technologies and care models (e.g., remote monitoring, clinical pathways, tech-enabled care).
• Lead regional implementation of clinical focused strategic programs.
• Collaborate with vendor partnerships and evaluate performance against clinical and financial KPIs.
• May also be involved in governance committees and delegation oversight.

Use your skills to make an impact!

Qualifications

• Active MD or DO licensure with appropriate training and certification.
• 5+ years of clinical practice.
• 5+ years in the managed care industry, either provider or payer.
• Thorough knowledge of health care utilization and quality metrics and the impact value-based contracting has on providers.