Become a part of our caring community and help us put health first
 

The Regional VP, Health Services will provide medical leadership and strategy for the Health Services Operations, which includes: Care Management for D-SNP, BadgerCare+, and SSI contracts; Quality and Population Health functions; Prior Auth and Utilization Mgmt; and Pharmacy.  Has fiscal responsibility for trend management across all medical and pharmacy related cost drivers.

The Regional VP, Health Services will provide medical leadership and strategy for the Health Services Operations, which includes: Care Management for D-SNP, BadgerCare+, and SSI contracts; Quality and Population Health functions; Prior Auth and Utilization Mgmt; and Pharmacy.  Has fiscal responsibility for trend management across all medical and pharmacy related cost drivers.

•Oversee regional utilization management and case management for inpatient cases (acute care hospital, LTAC, Acute rehab, SNF, Pharmacy, and MLTSS) according to the Humana Medicaid and Medicare Model of Care.

•Participate in Quality/Population Health 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, Population Health, Pharmacy and Care Management 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 and partner across shared service and support functions.

•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

•8 or more years of management experience

•Must live in Wisconsin and have a current/unrestricted medical license and willing to obtain license, as required, for various states in region of assignment.

•MD or DO degree

•Excellent communication skills

•5 years of established clinical experience

•Knowledge of the managed care industry including Medicare, Medicaid and or MLTSS 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, Hospitalist, ER, PM&R clinical specialists

•Board Certified in an approved ABMS Medical Specialty

•Master's Degree

#PhysicianCareers

Use your skills to make an impact
 

Required Qualifications

•8 or more years of management experience

•Must live in Wisconsin and have a current/unrestricted medical license and willing to obtain license, as required, for various states in region of assignment.

•MD or DO degree

•Excellent communication skills

•5 years of established clinical experience

•Knowledge of the managed care industry including Medicare, Medicaid and or MLTSS 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, Hospitalist, ER, PM&R clinical specialists

•Board Certified in an approved ABMS Medical Specialty

•Master's Degree

#PhysicianCareers

Scheduled Weekly Ho