Remote Medicaid Value-Based Programs Lead

Humana Inc; Augusta (ME); Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Remote position

Travel up to 10%

Bonus incentive plan

Job summary

Humana Healthy Horizons seeks a Value-Based Programs Lead to drive end-to-end VBP model development and implementation for Medicaid providers. You will analyze data, design payment models, and create reporting packages to improve care quality and cost efficiency.

The role requires senior expertise in VBP and managed care, with strong collaboration across finance and operations. Remote work is supported, with occasional travel as needed.

Qualifications

• Bachelor's degree in a relevant field.
• 5+ years in managed care operations, provider reimbursement, analytics, and value-based care.
• Expertise in VBP model design and strategy with specialty providers (pay for performance, bundles, accountable care, shared savings and risk).
• Experience with Medicare and/or Medicaid managed care.
• Ability to analyze financial, utilization, and performance data.
• Ability to solve complex business problems in a matrixed environment.
• Strong written and verbal communication and presentation skills for leadership.

Responsibilities

• Develop new innovative VBP models for a range of provider types, including 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 requirements and RFP commitments.
• Analyze financial, utilization, and performance data to identify opportunities to improve quality and reduce total cost of care.
• Create VBP payment strategies and model design with appropriate metrics and terms.
• Design provider reporting packages to help understand performance.
• Partner with finance for impact analysis and modeling of new VBP models.
• Collaborate to operationalize and rollout new VBP models and address gaps.
• Monitor KPIs and refine model design based on feedback and data.
• Translate strategy into piloted and scalable models across markets.

Skills

VBP model design

Medicare/Medicaid

Data analysis

Matrixed environment

Communication skills

Problem solving

Education

Bachelor's degree

Master's degree

Job description

Humana Healthy Horizons seeks a Value-Based Programs Lead to drive end-to-end VBP model development and implementation for Medicaid providers. You will analyze data, design payment models, and create reporting packages to improve care quality and cost efficiency.

The role requires senior expertise in VBP and managed care, with strong collaboration across finance and operations. Remote work is supported, with occasional travel as needed.