Remote Value-Based Programs Lead

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

Benefits offered by this job

Bonus incentive plan

Comprehensive benefits

Job summary

Humana is seeking a Value-Based Programs Lead to support end-to-end operational management of Medicaid VBP models and provider relationships. You will drive model design, reporting, and analytical insight to improve quality and manage total cost of care.

The role requires 5+ years in managed care, VBP strategy, and Medicare/Medicaid expertise, with strong communication skills. This remote position may require up to 10% travel and is aligned with EST business hours.

Qualifications

• Bachelor’s degree is required.
• Minimum 5 years of experience in managed care operations, provider reimbursement and analytics, and value-based care.
• Expertise in VBP model design and strategy with specialty providers (pay for performance, bundles, ACO, shared savings and risk).
• Expertise in Medicare and/or Medicaid managed care.
• Ability to analyze financial, utilization, and performance data.
• Ability to identify, structure and solve complex business problems.
• Experience in a matrixed environment.
• Excellent interpersonal, organizational, written, and oral communication and presentation skills.

Responsibilities

• Develop new innovative VBP models for provider types (behavioral health, maternity, specialists, SDOH).
• Align scope of work with roadmap for VBP model development.
• Analyze financial, utilization, and performance data to drive quality and cost improvements.
• Create VBP payment strategies and model design with metrics and terms.
• Design provider reporting packages to explain performance.
• Partner with finance for impact analysis and modeling of new VBP models.
• Collaborate across teams to operationalize and roll out VBP models.
• Monitor VBP KPIs and refine model design based on feedback.

Skills

Financial data analysis

Problem solving

Communication skills

Matrixed environment experience

Presentation skills

Education

Bachelor’s degree

Master’s degree (preferred)

Job description

Humana is seeking a Value-Based Programs Lead to support end-to-end operational management of Medicaid VBP models and provider relationships. You will drive model design, reporting, and analytical insight to improve quality and manage total cost of care.

The role requires 5+ years in managed care, VBP strategy, and Medicare/Medicaid expertise, with strong communication skills. This remote position may require up to 10% travel and is aligned with EST business hours.