Regional VP, Health Services

• 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.

Requirements

• 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.
• 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

🔍 ATS Optimization Keywords
Below are skills and terms extracted directly from this job posting to improve Applicant Tracking System (ATS) visibility. This unique feature helps candidates tailor their applications more effectively — a feature exclusive to JobTailor job listings.

Hard Skills

• utilization management
• case management
• quality management
• HEDIS
• STARS metrics
• clinical programs
• provider contracting
• discharge planning
• home health
• rehab

Soft Skills

• communication skills
• leadership
• problem solving
• interpersonal skills
• organizational skills
• team management
• strategic thinking
• adaptability
• collaboration
• passion for improvement

Certifications & Qualifications

• Louisiana medical license
• MD degree
• DO degree
• Board Certified in ABMS Medical Specialty