Regional VP, Health Services--Southeast Region

North Carolina, United States

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Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Services, Healthcare, InsuranceIndustries

Requirements

Candidates must possess an active MD or DO license with appropriate training and certification, along with at least 5 years of clinical practice and 5 years in the managed care industry. A thorough understanding of healthcare utilization and quality metrics, as well as the impact of value-based contracting, is required. The role also necessitates an in-depth understanding of how organizational capabilities interrelate across segments and enterprise-wide.

Responsibilities

The Regional VP, Health Services will shape and execute the region's clinical engagement strategy, driving quality improvement, cost efficiency, and population health outcomes through strategic provider partnerships. Responsibilities include cultivating trusted relationships with provider executives, serving as the lead clinical executive for provider groups, enhancing innovation with hospital systems, and driving population health initiatives. The role involves serving as the clinical steward for regional medical expense trends, collaborating on cost and quality outlier plans, providing clinical input into network development and contract negotiations, and representing the organization in regional health coalitions. Additionally, the VP will partner with national innovation teams to pilot and scale emerging technologies and care models, lead regional implementation of clinical strategic programs, and collaborate with vendor partnerships.

Skills

Clinical Strategy

Provider Partnerships

Population Health

Quality Improvement

Cost Efficiency

Data Analysis

Relationship Building

Medicare Advantage

Risk Adjustment

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.

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