Medicaid Regional VP, Health Services

Medicaid Regional VP, Health Services

Become a part of our caring community and help us put health first. The Medicaid Regional VP, Health Services relies on medical background to create and oversee clinical strategy for the region. The Medicaid Regional VP, Health Services requires an in-depth understanding of how organization capabilities interrelate across segments and / or enterprise-wide. The Medicaid Regional VP, Health Services will provide medical leadership and strategy for the Health Services Operations with fiscal responsibility for trend management.

Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTAC, Acute rehab, SNF) according to the Humana Medicaid Model of Care.

Participate in Quality Operations including chair Quality Management Committee, complete initial peer review on quality of care complaints, complete peer-to-peer written and verbal communications.

Oversee administrative budget for regional HSO & Quality Improvement including approve / deny expense reports & requisition requests for department members.

Oversee Quality Improvement and HEDIS / STARS metrics improvement with PCP offices and IPAs.

Participate in regional level committees and meetings setting medical necessity strategies.

Provide oversight and direction for the implementation of regional clinical programs and strategies, as well as, developing and implementing market level strategies.

Manage internal operational / functional relationships related to profitability.

Assist with network development and provider contracting with various providers and ancillary providers.

Serve as clinical liaison with inpatient facilities and joint operating committees to maintain facility relationship and problem solve; especially reviewing contracts as to clinical services.

Well-versed on financial aspects of various levels of risk bearing contracts and possess the ability to gain traction and adoption of the providers.

Ability to thrive in a highly matrix environment.

Use your skills to make an impact.

Required Qualifications

• 8 or more years of management experience
• Must live in Louisiana and have a current / unrestricted Louisiana medical license and willing to obtain license, as required, for various states in region of assignment. Preference is for someone to be located in Baton Rouge, and second preference would be New Orleans.
• MD or DO degree
• Board Certified in an approved ABMS Medical Specialty
• Excellent communication skills
• 5 years of established clinical experience
• Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products
• Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and / or home health or rehab
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications

Medical management experience, working with health insurance organizations, hospitals and other healthcare providers, patient interaction, etc.

Internal Medicine, Family Practice, OBGYN, Geriatrics, Hospitalist, ER, PM&R clinical specialists

Master's Degree

#PhysicianCareers Travel : While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours 40

Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $298,000 - $409,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and / or individual performance.

Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us Humana Inc. (NYSE : HUM) is committed to putting health first for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements.