Regional VP Health Services Mid-Atlantic Region

clevelcrossing.com - Jobboard • Bethesda, MD, United States • $200k - $250k / year • 2w ago

Regional VP Health Services Mid-Atlantic Region

Location: Bethesda, MD, United States

Posted on: Feb 21, 2022

Profile

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:

Serve as the Senior Physician for the Mid-Atlantic region, creating, implementing, and overseeing the clinical strategy.
Provide medical leadership and strategy for the region's Health Services Operations (HSO), including fiscal responsibility for managing medical cost trends.
Oversee regional utilization management for various case types, including inpatient care.
Supervise the region's Lead Medical Directors and Medical Directors.
Manage the administrative budget for regional HSO, reviewing expense reports and requisition requests.
Oversee clinical and quality metrics with PCP offices and IPAs, coordinating operational and clinical activities.
Participate in regional or Humana national level committees related to medical necessity determination and audit processes.
Provide oversight for the implementation of regional clinical programs and strategies.
Assist with network development and provider contracting.
Serve as clinical liaison in meetings with inpatient facilities and provider joint operating committees.
Understand financial aspects of risk-bearing contracts and promote provider adoption.
Thrive in a highly matrix environment.

Required Qualifications:

8 or more years of management experience within Healthcare.
A current and unrestricted physician license in at least one state.
MD or DO degree.
Board Certification in an approved ABMS Medical Specialty.
Excellent communication skills and effective business demeanor.
5 years of established clinical experience.
Knowledge of the managed care industry including Medicare, Medicaid, and/or Commercial products.
Analytic and interpretation skills with experience in quality management and utilization management.
Passionate about contributing to improving consumer experiences.

Covid 19 requirements:

You are required to be fully COVID vaccinated, or undergo weekly COVID testing and wear a face covering while working in a Humana office, or conducting any Humana business outside of your home.

Preferred Qualifications:

Medical management experience with health insurance organizations, hospitals, and other healthcare providers.
Internal Medicine, Family Medicine, Geriatrics, Hospitalist, Emergency Medicine, or Physiatry experience.
Master's Degree related to Management, Healthcare, or a related area.
Knowledge of Healthcare Providers and Health Care Delivery Systems within the applicable region.

Scheduled Weekly Hours: 40

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