Become a part of our caring community and help us put health first
The RVP, Health Services (Medical Director/Chief Medical Officer) is dedicated full-time to the Contractor’s Indiana Medicare & Medicaid Integrated program, Indiana PathWays for Aging. He/she will provide medical leadership, oversight and strategy for Indiana clinical programs while interacting with plan members and providers in order to improve member patient experience, to drive population health, and to ensure efficient delivery of care. The RVP, Health Services will be based in Indianapolis, IN and will work closely with plan leadership to integrate the day-to-day administration and strategic management of physical and behavioral health services, including utilization management (UM), quality improvement, and value-based payment programs. He/she will also oversee the development of new clinical products and services.
Position Responsibilities:
- Oversee the development of clinical practice guidelines and review any potential quality of care problems.
- Oversee the clinical management program and programs that address special needs populations and health screenings.
- Oversee Quality Improvement and HEDIS/STARS metrics improvement with PCP offices and IPAs.
- 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.
- Serve as the medical professional interface with primary medical providers (PMPs) and specialty providers.
- Direct the Quality Management and Utilization Management programs, including, but not limited to, monitoring, corrective actions, and other quality management, utilization management or program integrity activities.
- Responsible for ensuring that the medical management and quality management components of the operations are compliant with the terms of the Contract, in close coordination with other key staff.
- Work closely with the Pharmacy Director to ensure compliance with pharmacy-related responsibilities.
- Serve as the chairman of the Utilization Management committee.
- Serve as co-chairman of and participate in meetings of the PathWays Quality Management and Improvement Committee
- Attend all FSSA quality meetings, including the Quality Strategy Committee meetings and Subcommittee meetings.
- Responsible for taking appropriate action on all agenda and action items from all OMPP quality meetings.
Use your skills to make an impact
Required Qualifications
- Current and unrestricted Indiana-licensed Health Care Provider (IHCP) board certified in geriatrics, family medicine, or internal medicine (MD or DO degree)
- 8 or more years of management experience
- 5+ years of established clinical experience.
- 2+ years of quality management experience
- Excellent communication skills
- Proven experience building strong effective teams
- Knowledge of the managed care industry including Medicare and Medicaid.
- Possess analysis and interpretation skills with prior experience leading teams focusing on quality management, utilization management, discharge planning and/or home health or rehab.
- Strategic thinking with proven ability to communicate a vision and drive results.
- Solid negotiation and conflict management skills
- Creative problem-solving skills
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences.
- Must reside in the state of Indiana and commute to Indianapolis, IN office regularly.
Preferred Qualifications
- Indiana Licensed Geriatrician or Physician with ten (10) years of Clinical Practice with older adults (60 years of age and older)
- Medicaid Managed Care clinical or BH leadership experience
- Experience in palliative care, behavioral health, or adult medicine.
Scheduled Weekly Hours
40
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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, Medicaid, families, individuals, military service personnel, and communities at large.
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 because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, 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.
