Remote Value-Based Care Lead

Humana, Inc.; Atlanta (GA); Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Remote position

Up to 10% travel

40-hour workweek EST

Job summary

Humana Healthy Horizons is seeking a Value-Based Programs Lead to drive end-to-end operational support of Medicaid VBP models, partnering with provider networks to improve quality and reduce cost of care. You will translate strategies into scalable payment designs and reporting packages.

The role requires 5+ years in managed care and value-based care, experience building VBP strategies for specialty providers, and strong communication in a matrixed organization.

Qualifications

• Bachelor's degree required; advanced degree preferred.
• 5+ 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 design VBP arrangements with baselines and targets.
• Experience operating in a matrixed environment.
• Expertise in Medicare and/or Medicaid managed care.
• Strong written and verbal communication; able to present to management.

Responsibilities

• Develop new VBP models for provider types (behavioral health, maternity, specialists, SDOH).
• Align scope with roadmap and Medicaid contractual requirements and RFPs.
• Analyze financial, utilization and performance data to identify improvement opportunities.
• Create VBP payment strategies, model design, metrics and financial terms.
• Design provider reporting packages to show performance insights.
• Partner with finance for impact analysis and modeling.
• Collaborate to operationalize and rollout VBP models; address gaps.
• Monitor KPI and refine model design based on feedback and data.
• Translate strategy into pilottable, scalable models across markets.

Skills

VBP design

Analytics

Managed care

Communication

Matrixed teams

Provider reimbursement

Data analysis

Financial modeling

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, partnering with provider networks to improve quality and reduce cost of care. You will translate strategies into scalable payment designs and reporting packages.

The role requires 5+ years in managed care and value-based care, experience building VBP strategies for specialty providers, and strong communication in a matrixed organization.