Remote Medicaid Value-Based Programs Lead

Humana, Inc.; Hartford (CT); Remote; USD 104,000 - 143,000; Full time

Job summary

Humana Healthy Horizons is seeking a Value-Based Programs Lead to support successful value-based provider relationships and end-to-end operational support for Medicaid VBP models. You will be a subject-matter expert in VBP with advanced technical knowledge, shaping strategies, performance metrics, and financial terms.

The role requires 5+ years in managed care, provider reimbursement, and VBP design, with strong analytical and presentation skills.

Qualifications

• Five or more years in managed care operations, provider reimbursement and analytics, and value-based care.
• Two or more years designing, structuring, and implementing VBP strategies for specialty providers (pay-for-performance, bundled payments, accountable care, shared savings, shared-risk).
• Experience using financial, utilization, quality and performance data to design and model VBP arrangements, including baselines, benchmarks, targets and incentive/risk methodologies.
• Experience operating in a matrixed environment.
• Expertise in Medicare and/or Medicaid managed care.

Responsibilities

• Develop new innovative VBP models for a range of provider types (behavioral health, maternity, specialists, social determinants of health).
• Align work scope with roadmap to ensure 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 design with metrics, benchmarks and financial terms.
• Design provider reporting packages to help providers understand performance.
• Collaborate with finance to conduct impact analysis and modeling for new VBP models.
• Work with teams to operationalize and rollout VBP models and address gaps.
• Monitor VBP KPIs to refine model design based on feedback and data.
• Translate strategy into piloted and scalable models across markets.

Skills

Managed care operations

Provider reimbursement

Value-based care

VBP design

Data analysis

Cross-functional collaboration

Presentation skills

Communication skills

Education

Bachelor's degree

Job description

Humana Healthy Horizons is seeking a Value-Based Programs Lead to support successful value-based provider relationships and end-to-end operational support for Medicaid VBP models. You will be a subject-matter expert in VBP with advanced technical knowledge, shaping strategies, performance metrics, and financial terms.

The role requires 5+ years in managed care, provider reimbursement, and VBP design, with strong analytical and presentation skills.