Remote Value-Based Programs Lead

Humana, Inc.; Madison (WI); Remote; USD 104,000 - 143,000; Full time

Job summary

Humana Healthy Horizons is seeking a Value-Based Programs Lead to advance Medicaid VBP models and provider relationships. You will translate strategy into pilot-ready models, align with Medicaid requirements, and guide end-to-end operational delivery.

You will analyze data, design payment terms and performance metrics, and collaborate across teams to improve provider experience while driving value. The role is remote with up to 10% travel.

Qualifications

• Bachelor's degree required.
• 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 data to design and model VBP arrangements with baselines and benchmarks.
• 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 and implement VBP models across provider types (behavioral health, maternity, specialists, and social determinants of health).
• Align work with roadmap for new VBP model development to ensure Medicaid compliance.
• Analyze financial, utilization, and performance data to identify opportunities for quality and cost improvements.
• Design VBP payment strategies and model logic, metrics, benchmarks, and financial terms.
• Create provider reporting packages to help providers understand performance.
• Collaborate with finance for impact analysis and modeling of new VBP models.
• Operationalize and rollout new VBP models across markets and address gaps.
• Monitor KPIs and refine model design based on feedback and data.
• Translate strategy into pilot-ready, scalable models.

Skills

Analytical skills

Communication

Problem solving

Team collaboration

Presentation skills

Education

Bachelor's degree

Master's degree (preferred)

Job description

Humana Healthy Horizons is seeking a Value-Based Programs Lead to advance Medicaid VBP models and provider relationships. You will translate strategy into pilot-ready models, align with Medicaid requirements, and guide end-to-end operational delivery.

You will analyze data, design payment terms and performance metrics, and collaborate across teams to improve provider experience while driving value. The role is remote with up to 10% travel.