Regional VP, Health Services

Location: Northern

## Regional VP, Health Services Apply:
Remote Indiana:
Full time:
Posted Today:
R-428970#
** Become a part of our caring community
** The Medicaid Chief Medical Officer for Indiana provides market-based medical leadership and clinical strategy for Humana Healthy Horizons in Indiana. This leader oversees clinical operations, quality, utilization management, population health, and medical cost strategy while serving as a senior clinical representative with the State, providers, community partners, and other key stakeholders. Provides strategic and operational clinical leadership for all Indiana Medicaid lines of business, including Medicaid-only, Medicaid LTSS, and integrated Medicare-Medicaid products, including integrated D-SNP, as applicable.

The role also contributes to Indiana Medicaid business development by supporting procurement strategy, external relationship development, provider partnership opportunities, and differentiated clinical solutions that advance Humana’s growth, competitiveness, and long-term success in the state.

The Regional VP, Health Services will provide medical leadership and strategy for the Health Services Operations with fiscal responsibility for trend management.
* Support all Indiana Medicaid lines of business, including integrated D-SNP business development activities, including procurement strategy, stakeholder engagement, competitive market positioning, and the development of innovative clinical solutions that drive growth and strengthen Humana's presence in the state.
* Serve as a key clinical leader in a highly matrixed environment, collaborating across internal and external stakeholders to implement strategic initiatives and achieve business results.
* Provide medical leadership and oversight of utilization management, care management, quality operations, and medical necessity strategies to ensure high-quality, cost-effective care delivery.
* Oversees the clinical strategy, performance, compliance, and operational effectiveness of care management programs, ensuring alignment with state contract requirements, member needs, quality outcomes, utilization management priorities, and integrated model objectives.
* Lead market-level clinical programs and quality improvement initiatives, including HEDIS/STARS performance, peer review activities, and Quality Management Committee governance.

Partner with providers, facilities, and ancillary networks to strengthen relationships, support contracting activities, and drive adoption of value-based and risk-sharing arrangements.#
** Use your skills to make an impact
**** Required Qualifications
*** M.D. or D.O. degree with current, unrestricted medical license and board certification, with the ability to practice in Indiana.
* 10+ years of progressive clinical and healthcare leadership experience, including managed care, Medicaid, Medicare, or value-based care environments. Experience serving as the senior clinical leader for a Medicaid managed care organization, integrated care program, MLTSS program, D-SNP, FIDE-SNP, or other Medicare-Medicaid integrated model is preferred.
* Proven experience leading utilization management, care management, quality improvement, population health, and medical cost management strategies.
* Proven ability to influence executive leaders, state partners, and cross-functional teams to achieve clinical, operational, quality, and compliance objectives.
* Demonstrated success partnering with providers, health systems, community organizations, and government stakeholders to improve healthcare outcomes and drive business results.
* Strong strategic, financial, and executive leadership skills, with the ability to influence in a complex matrix organization and support growth, network, and procurement…