[Hiring] Regional VP, Health Services @Humana

Role Description

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.
• Contributes to Indiana Medicaid business development by supporting procurement strategy, external relationship development, provider partnership opportunities, and differentiated clinical solutions.
• Provides medical leadership and strategy for the Health Services Operations with fiscal responsibility for trend management.
• Supports all Indiana Medicaid lines of business, including integrated D-SNP business development activities.
• Serves as a key clinical leader in a highly matrixed environment, collaborating across internal and external stakeholders.
• Provides medical leadership and oversight of utilization management, care management, quality operations, and medical necessity strategies.
• Oversees the clinical strategy, performance, compliance, and operational effectiveness of care management programs.
• Leads market-level clinical programs and quality improvement initiatives, including HEDIS/STARS performance.
• Partners with providers, facilities, and ancillary networks to strengthen relationships and drive adoption of value-based arrangements.

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.
• 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.
• Demonstrated success partnering with providers, health systems, community organizations, and government stakeholders.
• Strong strategic, financial, and executive leadership skills.
• Experience working directly with state Medicaid agencies, CMS, accreditation organizations, and regulatory oversight entities.

Requirements

• Medical management experience, working with health insurance organizations, hospitals, and other healthcare providers.
• Internal Medicine, Family Practice, Geriatrics, Hospitalist, ER, PM&R clinical specialists.
• Master's Degree.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Time off (including paid time off, company and personal holidays, paid parental and caregiver leave).
• Short-term and long-term disability.
• Life insurance.
• Many other opportunities supporting whole-person well-being.

Work at Home Requirements

• Self-provided internet service must meet a minimum download speed of 25 Mbps and an upload speed of 10 Mbps.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel

• 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 year.
• This job is eligible for a bonus incentive plan based upon company and/or individual performance.

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.