Regional VP, Health Services - Remote Eligible

Regional VP Of Health Services

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. First and foremost, this is a role focused on building relationships with providers, and then leveraging those relationships to collaborate on how to positively drive provider performance, overcome operational barriers and reduce administrative burden.
• Serve as lead clinical executive for provider groups, translating clinical and quality priorities into actionable strategies. This includes promoting 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 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.

Qualifications:

• Active MD or DO licensure with appropriate training and certification
• 5+ years clinical practice
• 5 + years in managed care industry, either provider or payer.
• Thorough knowledge of health care utilization and quality metrics and the impact value-based contracting has on provider behavior and performance.
• The ability to quickly monitor clinical metrics and convey the impact verbally and in writing.
• Proficient communication skills, including interpersonal, written and presentation, and the ability to promote complex material in a way that can be understood and acted upon by others.
• Strategic thinker with the ability to balance long-term vision and short-term execution.
• Established track record of building successful teams and cross departmental relationships
• Travel required 30-35%
• Reside within the region's geographic boundaries

Preferred:

• Experience in both provider and payer roles
• Prior executive level role with successful track record of building external relationships and driving quality and financial results in a collaborative team/matrixed environment
• Advanced degree in business, management and/or population health.

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.$327,700 - $450,600 per yearThis 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

About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As a wholly owned subsidiary of Humana, CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties.

About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our 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.