Greater opportunities to build the life you want
Greater Peoria, IL
Greater Peoria, IL

Regional VP, Health Services



Remote · Florida, USA
Posted on Wednesday, January 31, 2024

Become a part of our caring community and help us put health first

The Regional VP, Health Services relies on medical background to create and oversee clinical strategy for the region. The Regional VP, Health Services requires an in-depth understanding of how organization capabilities interrelate across segments and/or enterprise-wide.

The 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 Medicare 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

•A current and unrestricted license in at least one jurisdiction 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

Preferred Qualifications

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

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

•Master's Degree


Scheduled Weekly Hours


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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.