Remote Value-Based Care Lead

Humana Inc; City of Albany (NY); Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Remote position

Up to 10% travel

EST business hours

Job summary

Humana Inc. is seeking a Value-Based Programs Lead for Humana Healthy Horizons to drive end-to-end VBP model development and provider relationships across Medicaid.

The role focuses on translating strategy into scalable models, designing payment terms, and creating provider reporting packages to improve value and reduce costs. You will analyze financial and utilization data, collaborate with finance, and work in a remote setting with occasional travel up to 10%.

Qualifications

• Bachelor's degree.
• Minimum 5 years in managed care operations, provider reimbursement and analytics, and value-based care.
• Expertise in VBP model design and strategy with specialty providers.
• Expertise in Medicare and/or Medicaid managed care.
• Ability to analyze financial, utilization, and performance data.
• Experience operating in matrixed environments.
• Strong communication and presentation skills with experience presenting to management.

Responsibilities

• Develop new VBP models for providers across specialties.
• Align scope of work with roadmap for VBP model development and Medicaid requirements.
• Analyze financial, utilization and performance data to drive quality and cost improvements.
• Create VBP payment strategies and model design with metrics and terms.
• Design provider reporting packages to explain performance.
• Partner with finance for impact analysis and modeling.
• Collaborate to operationalize and rollout new VBP models.
• Monitor VBP KPIs and iterate model design based on feedback.
• Translate strategy into piloted, scalable models across markets.

Skills

Value-based care

Data analysis

Stakeholder communication

Managed care

Medicaid knowledge

Presentation skills

Education

Bachelor's degree

Job description

Humana Inc. is seeking a Value-Based Programs Lead for Humana Healthy Horizons to drive end-to-end VBP model development and provider relationships across Medicaid.

The role focuses on translating strategy into scalable models, designing payment terms, and creating provider reporting packages to improve value and reduce costs. You will analyze financial and utilization data, collaborate with finance, and work in a remote setting with occasional travel up to 10%.