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Chief Medical Director Northeast Region: Regional VP, Health

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Job Details
Job Order Number
Company Name
Physical Address

Portland, ME 04104
Job Description


The Regional VP, Health Services relies on medical background to create and oversee clinical strategy for the region. The Regional VP, Health Services requires a 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.

Required Qualifications

+ Master’s Degree

+ 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, OBGYN, Hospitalist clinical specialists

Additional Information


Scheduled Weekly Hours


About Us

Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms -when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

Equal Opportunity Employer

It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster.

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