Remote Value-Based Programs Lead for Medicaid & VBP

Humana Inc; Denver (CO); Remote; USD 104,000 - 143,000; Full time

Job summary

Humana Healthy Horizons seeks a Value-Based Programs Lead to support value-based provider relationships and drive path-to-value goals. You will lead end-to-end operational support for specialty Medicaid VBP models, aligning with contractual requirements and strategy.

Strong VBP, analytics, and presentation skills are essential. Bachelor's degree and at least 5 years in managed care operations, reimbursement, and analytics are required; remote work possible with up to 10% travel.

Qualifications

• Bachelor's degree required.
• Minimum 5 years of experience in managed care operations, provider reimbursement and analytics.
• Expertise in VBP model design and strategy with specialty providers, including pay for performance, bundles, accountable care, and shared savings/risk models.
• Experience with Medicare and/or Medicaid managed care.
• Ability to analyze financial, utilization and performance data.
• Ability to solve complex business problems in a matrixed environment.

Responsibilities

• Develop new VBP models for behavioral health, maternity, specialists and SDoH.
• Align work scope with roadmap and Medicaid requirements.
• Analyze data to identify opportunities to improve quality and reduce total cost of care.
• Design VBP payment strategies, model logic, metrics and benchmarks.
• Develop provider reporting packages to explain performance.
• Partner with finance for impact analysis and modeling.
• Collaborate to operationalize, roll out VBP models and address gaps.
• Monitor KPI and refine model design based on feedback.

Skills

Managed care operations

Provider reimbursement

Analytics

VBP model design

Medicare/Medicaid

Data analysis

Presentation skills

Team collaboration

Education

Bachelor's degree

Master's degree (preferred)

Tools

Excel

Data visualization tools

Job description

Humana Healthy Horizons seeks a Value-Based Programs Lead to support value-based provider relationships and drive path-to-value goals. You will lead end-to-end operational support for specialty Medicaid VBP models, aligning with contractual requirements and strategy.

Strong VBP, analytics, and presentation skills are essential. Bachelor's degree and at least 5 years in managed care operations, reimbursement, and analytics are required; remote work possible with up to 10% travel.