Value-Based Care Programs Lead (Remote)

Humana Inc; San Juan (PR); Remote; USD 104,000 - 143,000; Full time

Job summary

Humana Inc. is seeking a Value-Based Programs Lead to advance value-based provider relationships and oversee VBP model development for Medicaid. You will analyze data, design payment strategies, and collaborate across finance and operations to scale innovative models.

This remote role requires strong expertise in VBP, managed care, and performance analytics, with travel up to 10% for onsite meetings and a baseline of 40 hours per week.

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 range of provider types, such as behavioral health, maternity, specialists, and social determinants of health, 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.
• Creation of VBP payment strategies and model design, such as developing payment model logic, performance metrics and benchmarks, and financial terms, which align with segment goals.
• Design and contribute to development of provider reporting packages to help providers understand their overall and detailed 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. Contribute to developing solutions to operational gaps.
• Monitor VBP model performance KPIs to identify opportunities to enhance model design based on internal and external feedback and performance data.
• Ability to translate strategy into models that can be piloted and scaled across markets.

Skills

VBP modeling

Medicare/Medicaid experience

Data analysis

Provider reimbursement

Matrixed environment

Communication

Education

Bachelor's degree

Master's degree

Job description

Humana Inc. is seeking a Value-Based Programs Lead to advance value-based provider relationships and oversee VBP model development for Medicaid. You will analyze data, design payment strategies, and collaborate across finance and operations to scale innovative models.

This remote role requires strong expertise in VBP, managed care, and performance analytics, with travel up to 10% for onsite meetings and a baseline of 40 hours per week.