Strategic Lead, Value-Based Care & Medicaid Models

Humana, Inc.; Richmond (VA); Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Remote work

Job summary

Humana Healthy Horizons seeks a Value-Based Programs Lead to advance care delivery through innovative VBP models. You will own end-to-end operational support for specialty Medicaid value-based payment programs, aligning with strategic goals and regulatory requirements.

You will leverage financial, utilization, and quality data to shape payment terms, performance metrics, and risk methodologies, while collaborating with cross-functional teams to scale models across markets.

Qualifications

• Bachelor’s degree required.
• 5+ years in managed care operations, provider reimbursement and analytics.
• 2+ years designing value-based payment strategies and models for specialty providers.

Responsibilities

• Lead development of value-based payment (VBP) models across provider types.
• Analyze financial, utilization and performance data to drive quality and cost improvements.
• Design VBP payment strategies, metrics, benchmarks and terms.
• Develop provider reporting packages to communicate performance.
• Collaborate with finance to perform impact analysis and modeling.
• Operationalize and rollout new VBP models across markets.
• Monitor KPI performance and refine model design based on data.

Skills

Value-based care

Provider reimbursement

Analytics

Matrixed environment

Communication skills

Presentation skills

Education

Bachelor's degree

Master's degree

Job description

Humana Healthy Horizons seeks a Value-Based Programs Lead to advance care delivery through innovative VBP models. You will own end-to-end operational support for specialty Medicaid value-based payment programs, aligning with strategic goals and regulatory requirements.

You will leverage financial, utilization, and quality data to shape payment terms, performance metrics, and risk methodologies, while collaborating with cross-functional teams to scale models across markets.