Remote Lead, Value-Based Care Programs

Humana, Inc.; Austin (TX); Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Remote work

Travel opportunities

Job summary

Humana Healthy Horizons is seeking a Value-Based Programs Lead to drive end-to-end operational support for Medicaid value-based payment models. You will shape VBP design, align with Medicaid contracts, and partner with finance to model impact and performance.

You will translate strategy into scalable pilots across markets, monitor KPIs, and collaborate with cross-functional teams to improve provider experience and advance value-based care initiatives.

Qualifications

• Bachelor's degree.
• 5+ years of experience in managed care operations, provider reimbursement and analytics.
• 2+ years designing, structuring, and implementing value-based payment (VBP) strategies and models for specialty providers.
• Experience using financial, utilization, quality, and performance data to design and model VBP arrangements, including baselines, benchmarks, and incentive methodologies.
• Experience operating in a matrixed environment.
• Expertise in Medicare and/or Medicaid managed care.
• Excellent interpersonal, organizational, written, and oral communication and presentation skills.

Responsibilities

• Develop new VBP models across provider types (behavioral health, maternity, specialists, etc.).
• Align scope of work with roadmap and Medicaid contractual requirements and RFP commitments.
• Analyze financial, utilization, and performance data to identify opportunities to improve quality and reduce cost of care.
• Create VBP payment strategies and model designs with appropriate metrics and benchmarks.
• Design provider reporting packages to help providers understand performance.
• Partner with finance for impact analysis and modeling of new VBP models.
• Collaborate to operationalize and rollout of new VBP models and address gaps.
• Monitor VBP KPIs to refine model design based on feedback and data.
• Translate strategy into pilotable, scalable models across markets.

Skills

Value-based care

Data analysis

Communication skills

Healthcare operations

Matrixed environment

Medicare/Medicaid

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 Medicaid value-based payment models. You will shape VBP design, align with Medicaid contracts, and partner with finance to model impact and performance.

You will translate strategy into scalable pilots across markets, monitor KPIs, and collaborate with cross-functional teams to improve provider experience and advance value-based care initiatives.