Remote Value-Based Care Programs Lead

Humana Inc; Cheyenne (WY); Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Remote work option

Job summary

Humana Healthy Horizons seeks a Value-Based Programs Lead to drive end-to-end operational support for specialty Medicaid value-based payment models. You will lead model design, performance analytics, and reporting to move providers from volume to value across markets.

The role requires a strong background in VBP, Medicare/Medicaid, and analytics, with excellent communication skills to partner with finance and cross-functional teams. Remote work with up to 10% travel.

Qualifications

• Bachelor's degree required.
• Minimum 5 years in managed care operations, provider reimbursement and analytics.
• Expertise in VBP design and strategy with specialty providers (pay for performance, bundles, accountable care, shared savings and risk).
• Expertise in Medicare/Medicaid managed care.
• Ability to understand and analyze financial, utilization, and performance data.
• Ability to identify, structure and solve complex business problems.
• Experience operating in a matrixed environment.
• Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience delivering to management.

Responsibilities

• Develop new innovative VBP models for a range of provider types (behavioral health, maternity, specialists, social determinants of health).
• Align scope of work with roadmap for new VBP model development and Medicaid contractual requirements.
• Analyze financial, utilization, and performance data to identify opportunities to improve quality and lower costs.
• Design VBP payment strategies and model logic, metrics, benchmarks, and terms.
• Develop provider reporting packages to help providers understand performance.
• Partner with finance for impact analysis and modeling of new VBP models.
• Collaborate with teams to rollout new VBP models and address operational gaps.
• Monitor VBP KPIs and refine model design based on feedback.
• Translate strategy into pilot-ready models scalable across markets.

Skills

Bachelor's degree

5+ years MCO

VBP model design

Medicare/Medicaid

Data analysis

Matrixed environment

Presentation skills

Education

Bachelor's degree

Master's degree

Job description

Humana Healthy Horizons seeks a Value-Based Programs Lead to drive end-to-end operational support for specialty Medicaid value-based payment models. You will lead model design, performance analytics, and reporting to move providers from volume to value across markets.

The role requires a strong background in VBP, Medicare/Medicaid, and analytics, with excellent communication skills to partner with finance and cross-functional teams. Remote work with up to 10% travel.