Remote Value-Based Care Programs Lead

Humana; United States; Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Remote work

Travel up to 10%

Job summary

Humana Healthy Horizons is seeking a Value-Based Programs Lead to guide end-to-end operational support of Medicaid value-based payment models, aligning with segment strategy and goals. You will serve as a VBP subject matter expert, translating strategy into scalable models across markets.

In this remote role, you’ll design payment model logic, performance metrics, and provider reporting, collaborate with finance for impact analyses, and drive improvements in quality and total cost of care while

Qualifications

• 5+ years in managed care operations, provider reimbursement and analytics, and value-based care.
• 2+ years designing, structuring, and implementing VBP strategies for specialty providers.
• Experience using financial, utilization, quality, and performance data to model VBP arrangements.
• Experience operating in a matrixed environment.
• Expertise in Medicare and/or Medicaid managed care.
• Excellent interpersonal, organizational, written, and oral communication and presentation skills.

Responsibilities

• Develop new innovative VBP models for provider types, including behavioral health, maternity, specialists, and SDOH.
• Align scope of work with roadmap for new VBP model development ensuring Medicaid requirements and RFP commitments.
• 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 with metrics, benchmarks, and financial terms.
• Design provider reporting packages to help providers understand performance.
• Partner with finance to conduct impact analyses and modeling for new VBP models.
• Collaborate with teams to operationalize and rollout of new VBP models and address gaps.
• Monitor VBP KPIs to enhance model design based on feedback and data.
• Translate strategy into models that can be piloted and scaled across markets.

Skills

VBP design

Medicare/Medicaid expertise

Data analysis

Matrixed environment

Communication skills

Problem solving

Education

Bachelor's degree

Master's degree (preferred)

Job description

Humana Healthy Horizons is seeking a Value-Based Programs Lead to guide end-to-end operational support of Medicaid value-based payment models, aligning with segment strategy and goals. You will serve as a VBP subject matter expert, translating strategy into scalable models across markets.

In this remote role, you’ll design payment model logic, performance metrics, and provider reporting, collaborate with finance for impact analyses, and drive improvements in quality and total cost of care while