Regional VP Health Services Mid-Atlantic Region

Regional VP Health Services Mid-Atlantic Region

Location : Washington, DC, United States

Posted on : Feb 21, 2022

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Job Information : Humana

Regional VP, Health Services (Mid-Atlantic Region)

Description :

The Regional VP, Health Services relies on medical background and reviews health claims. The Regional VP, Health Services requires an in-depth understanding of how organization capabilities interrelate across segments and / or enterprise-wide.

Responsibilities :

The Regional VP, Health Services will serve as the Senior Physician for the Mid-Atlantic region. They will rely on their medical background, health plan expertise, and professional relationships to create, implement, and oversee the clinical strategy for the region. The Regional VP, Health Services will :

• Provide medical leadership and strategy for the region's Health Services Operations (HSO), including fiscal responsibility for managing medical cost trends for the Mid-Atlantic region.
• Oversee regional utilization management for case types including but not limited to inpatient (acute care hospital, LTAC, Acute rehab, SNF), as well as according to the Humana Medicare Model of Care.
• Supervise the region's Lead Medical Directors or a team of Medical Directors.
• Oversee administrative budget for regional HSO, including reviewing all expense reports & requisition requests for associates within your reporting structure and approving / denying those requests.
• Oversee clinical and quality metrics with PCP offices and IPAs along with coordination of operational and clinical activities across regional functional teams.
• Participate in regional or Humana national level committees, including meetings related to medical necessity determination processes and Medical Director audit processes.
• 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 for your organization related to profitability.
• Assist with network development and provider contracting with various providers and ancillary providers.
• Serve as clinical liaison and medical leader in meetings and conversations with inpatient facilities and provider joint operating committees to maintain facility relationships and participate in problem-solving.
• Be well-versed on financial aspects of various levels of risk-bearing contracts, and possess the ability to gain traction for provider adoption.
• Ability to thrive in a highly matrix environment.
• Understand how organization capabilities interrelate across segments and / or enterprise-wide.

Required Qualifications :

8 or more years of management experience within Healthcare.

A current and unrestricted physician license in at least one state or jurisdiction, and must have willingness to obtain additional licenses, if required, in states within the Humana Medicare Advantage management region.

MD or DO degree.

Must have and maintain Board Certification in an approved ABMS Medical Specialty.

Must have excellent communication skills, and maintain effective business demeanor.

5 years of established clinical experience.

Knowledge of the managed care industry including Medicare, Medicaid, and / or Commercial products.

Possess analytic and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning, home health, and / or rehabilitation.

Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Covid 19 Requirements :

You are required to be fully COVID vaccinated, or you must undergo weekly COVID testing and wear a face covering while working in a Humana office or conducting any Humana business outside of your home. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If an employment offer is made, you will be required to :

Provide proof of full vaccination OR

Commit to weekly testing, following all CDC protocols, OR

Provide documentation for a medical or religious exemption consideration. This policy will not supersede state or local laws. Requests for these exemptions should be submitted at least 2 weeks prior to your scheduled first day of work.

Preferred Qualifications :

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

Internal Medicine, Family Medicine, Geriatrics, Hospitalist, Emergency Medicine, or Physiatry.

Master's Degree related to Management, Healthcare, or other area related to Health.

Knowledge of Healthcare Providers and Health Care Delivery Systems with the applicable region.

Location : in office or WAH with strong preference of Richmond, VA but needs to reside within the market (VA, MD, DC, DE, NC).

Scheduled Weekly Hours : 40

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