Remote Medicaid Value-Based Programs Lead

Humana, Inc.; Nashville (TN); Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Remote work

Up to 10% travel

Job summary

Humana Healthy Horizons seeks a Value-Based Programs Lead to strengthen Medicaid VBP relations, design models, and guide end-to-end operations with a focus on provider experience and value outcomes.

You will analyze financial and utilization data, build payment strategies, and partner with cross-functional teams to pilot and scale VBP models across markets, while ensuring compliance and performance reporting.

Qualifications

• Bachelor's degree required.
• Minimum five years in managed care operations, provider reimbursement and analytics, and value-based care.
• 2+ years designing and implementing VBP strategies for specialty providers.
• Experience using financial, utilization, quality data to model VBP arrangements.

Responsibilities

• Develop and lead end-to-end VBP initiatives with Medicaid/health plan partners.
• Create VBP payment strategies, metrics, and benchmarks aligned to goals.
• Design provider reporting packages to inform performance.
• Collaborate with finance to conduct impact analysis and modeling.
• Monitor KPIs and iterate model design based on feedback.

Skills

VBP design

Data analysis

Provider reimbursement

Stakeholder communication

Matrixed environment

Education

Bachelor's degree

Master's degree

Job description

Humana Healthy Horizons seeks a Value-Based Programs Lead to strengthen Medicaid VBP relations, design models, and guide end-to-end operations with a focus on provider experience and value outcomes.

You will analyze financial and utilization data, build payment strategies, and partner with cross-functional teams to pilot and scale VBP models across markets, while ensuring compliance and performance reporting.