Role: Regional Vice President - Provider Experience
Location: Central West
Assignment Capsule The Regional VP, Provider Experience will be accountable for the development of strategic provider relationships at the regional level for all product lines. This position will develop provider networks that help advance Humana’s strategy and goals toward improving the health of the communities we serve. This position will lead the transition of targeted membership and providers to engagement agreements and work with potential joint ventures, acquisitions and other innovative partnership opportunities.This position reports to a Regional President.
Strategic Provider Partner for all segments (Medicare, Commercial and Medicaid), accountable for developing and maintaining provider engagement and networks for a region. Ensure adequate coverage of primary care, specialty and ancillary services for Humana to meet both regulatory and strategic needs.
Prioritize and align strategy between different segments and functions. Be the defined point of contact for all providers and all product lines. Develop and execute shared strategy with Sales Organization to grow market share with engaged providers. Help develop strategies which will increase sales for retention and for growth.
Develop strategy for providers to move along path to value and influence providers to explore emerging value-based arrangements
Oversee regional and provider-specific quality, financial and operational performance. Accountable for provider engagement and improvement opportunities.
Transition targeted membership to engagement agreement and reduce costs via negotiations with key providers and trend management. Ensure access to care for members, network adequacy and gap closure.
Maintain commercial parity pricing in key commercial markets
Deliverdifferentiated provider experience via team leadership and own relationship with all regional key providers. 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. Leadinitiatives to enhance productivity, develop talent, and change leadership.
Leadership (leads positively and change leadership)
Aligning Systems for Performance
Drives Organizational Excellence
Business and Financial Acumen
Deep knowledge of Humana’s products, including Medicare, Commercial and Medicaid. Proven experience developing multi-product strategy for provider contracting and provider engagement activities for all lines of business.
Strategic, enterprise-wide and integrated thinking; fosters a collaborative culture among cross functional business partners to drive business results
Demonstrated experience leading large teams, setting vision and goals, aligning talent, developing teams and associates, leading change and leading positively.
Demonstrated success driving results and executing strategy effectively.
Experience analyzing the financial viability of complex provider contracts
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.
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 operational leadership experience; demonstrated ability to partner across functions to create and deploy win/win strategies.
Bachelor’s degree in Finance, Health Care Administration or related field required; MBA and/or JD degree preferred.
7 years of business leadership experience, with a minimum of five years in a managed care environment as the leader of a network development/provider relations function, with two or more years of experience leading contracting for Medicare products.
Additional Information - Regions/Hiring Manager
Incumbent will be expected to reside within regional assignment. Relocation assistance will be available.
Title: Regional Vice President - Provider Experience Central West
Requisition ID: 177384