Remote Value-Based Programs Lead for Medicaid

Humana Inc; Salem (OR); Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Bonus eligibility

Job summary

Humana Inc is seeking a Value-Based Programs Lead to drive end-to-end operational support for Medicaid VBP models, improve provider experience, and advance path-to-value goals. You will translate strategy into scalable models and collaborate with cross-functional teams to pilot and roll out initiatives.

This is a remote position with up to 10% travel and a 40-hour workweek. Salary ranges from $104,000 to $143,000 per year with bonus eligibility.

Qualifications

• Bachelor's degree.
• 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, including pay for performance, bundles, accountable care, and shared savings and risk models.
• Expertise in Medicare and/or Medicaid managed care.
• Ability to understand and analyze financial, utilization, and performance data.
• Ability to identify, structure and solve complex business problems.
• Experience operating in matrixed environment.
• Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of the management team.

Responsibilities

• Develop new innovative VBP models for a range of provider types, creating glide paths to move providers from volume to value.
• Align scope of work with roadmap for new VBP model development to ensure compliance with Medicaid contractual requirements and RFP commitments.
• Analyze financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care.
• Design and contribute to development of provider reporting packages to help providers understand their performance.
• Partner with finance team to conduct impact analysis and modeling for new VBP models.
• Collaborate with team members and matrixed teams to operationalize and rollout of new VBP models; develop solutions to operational gaps.
• Monitor VBP model performance KPIs to identify opportunities to enhance model design based on feedback and data.
• Translate strategy into models that can be piloted and scaled across markets.

Skills

VBP design & strategy

Provider reimbursement analytics

Managed care operations

Data analysis

Cross-functional collaboration

Education

Bachelor's degree

Master's degree

Job description

Humana Inc is seeking a Value-Based Programs Lead to drive end-to-end operational support for Medicaid VBP models, improve provider experience, and advance path-to-value goals. You will translate strategy into scalable models and collaborate with cross-functional teams to pilot and roll out initiatives.

This is a remote position with up to 10% travel and a 40-hour workweek. Salary ranges from $104,000 to $143,000 per year with bonus eligibility.