Remote Lead, Value-Based Care Programs

Humana Inc; Boise (ID); Remote; USD 104,000 - 143,000; Full time

Job summary

Humana Healthy Horizons is seeking a Value-Based Programs Lead to drive end-to-end operational support of Medicaid VBP models, advancing provider relationships and improving value-based care outcomes.

The role requires 5+ years in managed care operations, with expertise in VBP design and Medicare/Medicaid knowledge, plus strong data analysis and communication skills. Remote work with up to 10% travel and EST hours are typical.

Qualifications

• Bachelor's degree required.
• 5+ years of experience in managed care operations, provider reimbursement and analytics, and value-based care.
• Expertise in VBP design and strategy with specialty providers.
• Expertise in Medicare and/or Medicaid managed care.
• Ability to understand and analyze financial, utilization, and performance data.
• Experience operating in a matrixed environment.
• Excellent interpersonal, organizational, written, and oral communication and presentation skills.

Responsibilities

• Develop new innovative VBP models for a range of provider types, such as behavioral health, maternity, specialists, and social determinants of health.
• Align scope of work with roadmap for new VBP model development to ensure compliance with Medicaid contractual requirements and RFP commitments.
• Analyze financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care.
• Create VBP payment strategies and model design, such as developing payment model logic, performance metrics and benchmarks, and financial terms.
• Design and contribute to development of provider reporting packages to help providers understand their overall and detailed performance.
• Partner with finance team to conduct impact analysis and modeling for new VBP models.
• Collaborate with team members and matrixed teams to operationalize and rollout of new VBP models.
• Monitor VBP model performance KPIs to identify opportunities to enhance model design based on feedback and data.
• Ability to translate strategy into models that can be piloted and scaled across markets.

Skills

VBP model design

Medicare/Medicaid knowledge

Data analysis

Communication

Provider reimbursement analytics

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 of Medicaid VBP models, advancing provider relationships and improving value-based care outcomes.

The role requires 5+ years in managed care operations, with expertise in VBP design and Medicare/Medicaid knowledge, plus strong data analysis and communication skills. Remote work with up to 10% travel and EST hours are typical.