Remote Value-Based Programs Lead for Medicaid

Humana, Inc.; Phoenix (AZ); Remote; USD 104,000 - 143,000; Full time

Job summary

Humana Healthy Horizons is seeking a Value-Based Programs Lead to advance value-based provider relationships and improve the provider experience. You will guide end-to-end operational support of Medicaid VBP models in line with segment strategy and goals.

The role requires 5+ years in managed care, VBP design for specialty providers, and strong analytics. You will develop models, analyze data, design payment terms, and partner with finance to assess impact.

Qualifications

• Bachelor's degree in a related field with 5+ years in managed care operations and analytics.
• 2+ years designing, structuring, and implementing VBP strategies for specialty providers.
• Experience using data to design VBP arrangements including baselines, benchmarks, incentives.
• Experience operating in a matrixed environment.
• Expertise in Medicare and/or Medicaid managed care.
• Strong written and oral communication and presentation skills.

Responsibilities

• Develop new VBP models for providers, including pay-for-performance, bundles, ACOs, shared-savings.
• Align scope of work with roadmap and ensure Medicaid contractual compliance.
• Analyze financial, utilization, and performance data to drive quality and cost improvements.
• Design VBP payment strategies, metrics, benchmarks, and financial terms aligned to goals.
• Create provider reporting packages to show performance insights.
• Collaborate with finance to conduct impact analysis for new models.
• Operationalize and rollout VBP models across markets; close gaps.
• Monitor KPIs and refine model design from feedback and data.
• Translate strategy into piloted, scalable models.

Skills

Managed care

Provider reimbursement

Analytics

Value-based care

Communication

Presentation skills

Education

Bachelor's degree

Master's degree

Job description

Humana Healthy Horizons is seeking a Value-Based Programs Lead to advance value-based provider relationships and improve the provider experience. You will guide end-to-end operational support of Medicaid VBP models in line with segment strategy and goals.

The role requires 5+ years in managed care, VBP design for specialty providers, and strong analytics. You will develop models, analyze data, design payment terms, and partner with finance to assess impact.