Remote Value-Based Care Programs Lead

Humana Inc; Columbus (OH); Remote; USD 104,000 - 143,000; Full time

Job summary

Humana Healthy Horizons is seeking a Value-Based Programs Lead to drive end-to-end operational support for specialty Medicaid value-based payment models, aligning with segment strategy and goals. This role requires deep VBP expertise and the ability to translate strategy into pilotable models across markets.

The ideal candidate will analyze financial and performance data, develop payment strategies, and collaborate with finance to model impact while supporting provider reporting and stakeholder

Qualifications

• Minimum 5 years of experience in managed care operations, provider reimbursement and analytics.
• Expertise in VBP model design and strategy with specialty providers, including pay-for-performance, bundles, accountable care, and shared savings and risk models.
• Expertise in Medicare and/or 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 writing and delivering presentations 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 ensure compliance with Medicaid requirements and RFPs.
• Analyze financial, utilization, and performance data to identify opportunities to improve quality or reduce total cost of care.
• Create VBP payment strategies and model design, including payment logic, metrics, benchmarks and financial terms.
• Design provider reporting packages to help providers understand performance.
• Collaborate with finance to perform impact analyses and modeling for new VBP models.
• Work with teams to operationalize and roll out new VBP models and address gaps.
• Monitor VBP model KPIs and refine design based on feedback and data.
• Translate strategy into pilotable and scalable models across markets.

Skills

VBP model design

Data analysis

Healthcare payer operations

Medicare/Medicaid knowledge

Problem solving

Matrixed environment experience

Presentation skills

Education

Bachelor's degree

Master's degree (Preferred)

Job description

Humana Healthy Horizons is seeking a Value-Based Programs Lead to drive end-to-end operational support for specialty Medicaid value-based payment models, aligning with segment strategy and goals. This role requires deep VBP expertise and the ability to translate strategy into pilotable models across markets.

The ideal candidate will analyze financial and performance data, develop payment strategies, and collaborate with finance to model impact while supporting provider reporting and stakeholder