Regional VP Provider Experience

Profile

Description

Humana is a Fortune 50 market leader in integrated healthcare delivery. As a company whose primary focus is on the well-being of its members, Humana is dedicated to shifting perceptions of the health insurance industry. We believe our role goes beyond that of an insurer to that of a well-being partner. Through product and service offerings anchored in a whole-person view of human well-being, Humana embraces a focus on stimulating positive individual and population changes while nurturing a sense of security, enabling people to live life fully and be their most productive.

Against that backdrop, Humana is seeking an accomplished healthcare leader for the position of Regional Vice President, Provider Experience. The Regional Vice President will foster the development of strategic provider relationships for all product lines in North Carolina and Virginia . This position will develop provider networks that help advance Humana's strategy and goals toward improving the health of the communities we serve. The Regional Vice President will also provide executive leadership to the Provider Contracting, Provider Education and Provider Engagement in support of Humana's Commercial, Medicare, and Medicaid lines of business. 25% travel should be expected in this role.

This position reports to the Southeast Region President and will lead 60 associates with 10 direct reports. This person must reside within the Southeast Region, ideally in either North Carolina or Virginia, but locations in Georgia or South Carolina will also be considered, including work-at-home within those states.

Responsibilities

Key Responsibilities

Strategic Partner with all segments (Medicare, Group and Medicaid) accountable for developing and maintaining strategic network relationships with regional providers. Ensure adequate coverage of primary care, specialty and ancillary services for Humana to meet both regulatory and sales support need.

Align strategy and priority between different segments/functions and be the defined point of contact for escalated provider engagements and issues.

Lead the transition of targeted membership and providers to engagement agreements.

Work with potential joint ventures and other innovative partnership opportunities.

Develop and lead efforts re: continuous improvement for unit cost strategy.

Ensure access to care for members, network adequacy and gap closure.

Participate with Commercial and Medicare trend initiatives with key providers and partners.

Executive leadership of Provider Performance and Analytics functions, supporting Humana's value based contracts and trend bender initiatives.

Maintain commercial parity pricing with regional providers.

Manage across a highly matrixed organization aligning.

Incorporate provider feedback and practice perspective into strategy planning, development and operations; enhance the provider experience with Humana.

Align regional and corporate goals and drive these goals into the provider practice leveraging clinical resources.

Provide leadership to regional provider engagement, contracting, and operations teams.

Ensure regional operations are in alignment with the company's strategic objectives.

Leverage talent and resources and champion a collaborative and integrated work environment. Lead initiatives to enhance productivity, develop talent, and change leadership.

Key Candidate Qualifications :

The ideal candidate will have extensive business leadership experience, with several years in a managed care environment leading a network development/provider relations function, including proven experience leading contracting for Medicare products. He/she will possess comprehensive knowledge of health plan finance and the compensation arrangements between health plans and providers, including plan funding, risk management and provider reimbursement. The successful candidate will also hold a Bachelor's degree (MBA and/or JD degree preferred).

In addition, the following professional qualifications and personal attributes are sought:

Extensive leadership experience in the healthcare industry

Experience leading the end-to-end contract negotiation process through closure for all types of providers (physicians, hospitals, post-acute care facilities) and delegated specialty services.

Comprehensive knowledge of health plan finance and the compensation arrangements between health plans and providers

Knowledge of risk arrangements and ability to influence these arrangements.

Solid track record of hiring and developing talent and preparing associates for roles of broader and greater responsibility

Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Experience leading the 'end-to-end' contract negotiation process through closure for all types of providers (hospitals, physicians, post-acute care facilities) and delegated specialty services across Medicare, Medicaid and Employer Group segments.

The ability to identify health service expenses and implement cost control mechanisms within contracts.

Experience identifying and recruiting providers to ensure network alignment with planned sales process execution, orienting providers and managing relationships, and driving improvement in provider satisfaction via education, communication and streamlining claims resolution.

Prior executive leadership experience in sales, finance, legal, health services, and/or medical management; demonstrated ability to partner across functions to create and deploy win/win strategies.

Knowledge of risk arrangements and ability to influence these arrangements.

Recognition as a thought leader in the area of healthcare trend mitigation.

Ability to effectively navigate and manage through a matrixed organizational environment in a large (Fortune 250) company.

Strong relationship management skills, to teach, tailor, and take control of opportunity definition and initiation with business partners.

Excellent oral and written communications skills, including the polish, poise, and executive presence that will ensure effective interaction with audiences and positive representation of Humana in external forums.

Proven track record in team development and preparing direct reports for expanded responsibilities.

Scheduled Weekly Hours

40

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.

Company info

Humana Inc.
Website : http://www.humana.com