Remote Value-Based Programs Lead (Medicaid VBP)

Humana, Inc.; Jackson (MS); Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Remote position

Travel up to 10%

Bonus incentive plan

Job summary

Humana Healthy Horizons seeks a Value-Based Programs Lead to drive end-to-end VBP for Medicaid provider relationships, improving provider experience and achieving path-to-value goals.

The role covers model design, analytics, reporting, and cross-functional collaboration, with remote work and occasional travel to meet on-site needs.

Requires 5+ years in managed care, 2+ years in VBP design, strong data skills, and Medicare/Medicaid expertise.

Qualifications

• Bachelor's degree.
• 5+ years in managed care operations, provider reimbursement and analytics, and value-based care.
• 2+ years designing, structuring and implementing VBP for specialty providers (pay-for-performance, bundled payments, ACO, shared savings/risk).
• Experience using financial, utilization, quality data to design/model VBP with baselines/benchmarks and incentives.
• Experience operating in a matrixed environment.
• Expertise in Medicare and/or Medicaid managed care.
• Ability to identify, structure and solve complex business problems.
• Strong interpersonal, organizational, written and oral communication with presentations to management.

Responsibilities

• Develop new innovative VBP models for various provider types (behavioral health, maternity, specialists, SDOH).
• Align scope with roadmap for new VBP model development and Medicaid requirements.
• Analyze data to identify quality improvements and cost reductions.
• Design VBP payment strategies, using performance metrics and financial terms.
• Develop provider reporting packages to convey performance.
• Collaborate with finance on impact analysis and modeling for new VBP models.
• Operationalize and rollout new VBP models across markets; address gaps.
• Monitor KPIs and refine model design based on feedback.

Skills

VBP design

Data analytics

Matrixed environment

Communication

Problem solving

Education

Bachelor's degree

Job description

Humana Healthy Horizons seeks a Value-Based Programs Lead to drive end-to-end VBP for Medicaid provider relationships, improving provider experience and achieving path-to-value goals.

The role covers model design, analytics, reporting, and cross-functional collaboration, with remote work and occasional travel to meet on-site needs.

Requires 5+ years in managed care, 2+ years in VBP design, strong data skills, and Medicare/Medicaid expertise.