Medicaid Value-Based Programs Lead (Remote)

Humana, Inc.; Annapolis (MD); Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Remote position

Travel up to 10%

Job summary

Humana Healthy Horizons is seeking a Value-Based Programs Lead to drive end-to-end operational support for specialty Medicaid value-based payment models. You will develop VBP strategies, design models, establish benchmarks, and deliver provider reporting to improve care quality and reduce costs.

The role requires expertise in Medicare/Medicaid managed care, strong data analytics, and effective communication with management teams.

Qualifications

• Bachelor's degree required with strong background in managed care and analytics.
• Minimum five years in managed care operations, provider reimbursement and analytics and value-based care.
• Two or more years designing and implementing value-based payment strategies and models.

Responsibilities

• Develop and lead end-to-end operational support of Medicaid VBP models.
• Create VBP payment strategies, model design, metrics and benchmarks.
• Design provider reporting to communicate performance and insights.
• Partner with finance for impact analysis and modeling of VBP models.
• Collaborate across matrixed teams to rollout new VBP models and address gaps.
• Monitor KPIs and adjust model design based on feedback and data.
• Translate strategy into pilotable VBP models across markets.

Skills

VBP expertise

Data analysis

Provider reimbursement

Managed care operations

Education

Bachelor's degree

Master's degree

Job description

Humana Healthy Horizons is seeking a Value-Based Programs Lead to drive end-to-end operational support for specialty Medicaid value-based payment models. You will develop VBP strategies, design models, establish benchmarks, and deliver provider reporting to improve care quality and reduce costs.

The role requires expertise in Medicare/Medicaid managed care, strong data analytics, and effective communication with management teams.