Regional VP, Health Services

Humana Inc; Indianapolis (IN); On-site; USD 328,000 - 451,000; Full time

Job summary

Humana Inc. seeks a Medicaid Chief Medical Officer for Indiana to provide market-based medical leadership and clinical strategy across Indiana Medicaid lines of business, including integrated models.

You will oversee utilization management, quality, population health, and medical cost strategy while engaging with state partners, providers, and stakeholders to advance Humana’s goals. As Regional VP Health Services, you will lead clinical programs, oversee care management and quality initiatives,

Qualifications

• MD or DO degree with current, unrestricted license and board certification in Indiana.
• 10+ years of progressive clinical and healthcare leadership experience in Medicaid/Medicare or value-based care.
• Experience leading utilization management, care management, quality and cost management strategies.
• Proven ability to influence executive leaders and cross-functional teams.
• Experience collaborating with providers, health systems and government stakeholders.
• Strong strategic, financial and executive leadership skills in a matrix organization.
• Experience with state Medicaid agencies, CMS and regulatory bodies.

Responsibilities

• Provide medical leadership and strategy across Indiana Medicaid lines of business.
• Oversee clinical operations, utilization management, quality and cost strategies.
• Lead market-level clinical programs and quality improvement initiatives.
• Collaborate with external stakeholders, providers and state partners to drive growth and outcomes.
• Ensure compliance with contract requirements and integrated model objectives.

Education

MD/DO degree

Board certification

Job description

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 initiatives.
• Experience working directly with state Medicaid agencies, CMS, accreditation organizations, and regulatory oversight entities.

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
• #PhysicianCareers

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, 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. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

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. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.