Remote Value-Based Care Programs Lead

Humana Inc; Helena (MT); Remote; USD 104,000 - 143,000; Full time

Job summary

Humana Healthy Horizons is seeking a Value-Based Programs Lead to advance end-to-end VBP models across Medicaid segments. You will analyze financial and utilization data, design payment strategies, and create reporting packages to help providers understand performance.

This remote role exists to drive value-based care, quality, and cost improvements across markets. The role requires a Bachelor's degree and at least 5 years in managed care operations with VBP experience.

Qualifications

• Bachelor's degree required for role.
• 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.
• Experience with Medicare and/or Medicaid managed care.
• Ability to analyze financial, utilization and performance data.
• Ability to identify, structure and solve complex business problems.
• Experience operating in a matrixed environment.
• Strong interpersonal, organizational and communication skills.

Responsibilities

• Develop new innovative VBP models for multiple provider types such as behavioral health and maternity.
• Align work with roadmaps and Medicaid contractual requirements and RFP commitments.
• Analyze data to identify opportunities to improve quality and reduce costs.
• Design VBP payment strategies, metrics, benchmarks and terms.
• Create provider reporting packages to illustrate performance.
• Collaborate with finance for impact analysis and modeling.
• Work with teams to operationalize and rollout new VBP models.
• Monitor KPIs and refine model design based on feedback and data.
• Translate strategy into pilottable, scalable models across markets.

Skills

VBP model design

Provider reimbursement

Analytics

Medicare/Medicaid knowledge

Data analysis

Matrixed environment

Communication skills

Problem solving

Education

Bachelor's degree

Master's degree

Job description

Humana Healthy Horizons is seeking a Value-Based Programs Lead to advance end-to-end VBP models across Medicaid segments. You will analyze financial and utilization data, design payment strategies, and create reporting packages to help providers understand performance.

This remote role exists to drive value-based care, quality, and cost improvements across markets. The role requires a Bachelor's degree and at least 5 years in managed care operations with VBP experience.