Regional VP, 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, Health Insurance, Managed CareIndustries

Requirements

Candidates must possess an active MD or DO license with appropriate training and certification. A minimum of 5 years of clinical practice and 5 years in the managed care industry (provider or payer) is required. A thorough understanding of healthcare utilization and quality metrics, along with the impact of value-based contracting on providers, is essential. The role also requires an in-depth understanding of how organizational capabilities interrelate across segments and enterprise-wide.

Responsibilities

The Regional VP, Health Services will serve as the senior clinical executive responsible for shaping and executing the region’s clinical engagement strategy, driving quality improvement, cost efficiency, and population health outcomes. This includes cultivating trusted relationships with senior clinical leaders at provider organizations, translating clinical priorities into actionable strategies, and enhancing innovation with hospital systems. The role involves driving population health initiatives, championing condition-based interventions, and leading clinical strategies for unique populations. Additionally, the VP will serve as the clinical steward for regional medical expense trends, collaborating with finance and market leadership to implement targeted action plans, provide clinical input into network development and contract negotiations, and represent the organization in regional health coalitions. The position also entails partnering with national innovation teams to pilot and scale emerging technologies and care models, and leading regional implementation of clinical strategic programs.

Skills

Clinical Strategy

Provider Partnerships

Population Health

Quality Improvement

Cost Efficiency

Data Analysis

Relationship Building

Medicare Advantage

Clinical Metrics

Risk Adjustment

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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