Value-Based Care Programs Lead - Remote

Humana, Inc.; Trenton (NJ); Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Remote position

Travel up to 10%

Fixed schedule 40h EST

Job summary

Humana, Inc. is seeking a Value-Based Programs Lead to support Medicaid VBP initiatives and provider relationships. You will drive end-to-end operational support for specialty VBP models and work toward path-to-value goals across markets.

The role requires 5+ years in managed care operations, provider reimbursement and analytics, plus 2+ years designing VBP strategies for specialty providers. This remote role may require up to 10% travel, with 40-hour weeks aligned to EST.

Qualifications

• Bachelor's degree in a related field.
• 5+ years in managed care operations, provider reimbursement and analytics.
• 2+ years designing VBP strategies for specialty providers.
• Experience with data to design and model VBP arrangements.
• Experience in matrixed environment.
• Expertise in Medicare and/or Medicaid managed care.
• Excellent communication and presentation skills.

Responsibilities

• Develop new VBP models for provider types (behavioral health, maternity, specialists, etc.).
• Align scope with roadmap and Medicaid requirements and RFP commitments.
• Analyze financial, utilization, and performance data to identify opportunities for quality and cost improvements.
• Create VBP payment strategies and model design with aligned metrics and terms.
• Design provider reporting packages to help providers understand performance.
• Partner with finance for impact analysis and modeling of new VBP models.
• Collaborate with teams to rollout VBP models and address operational gaps.
• Monitor VBP KPIs and iterate model design based on feedback and data.
• Translate strategy into piloted and scalable models across markets.

Skills

VBP design

Provider reimbursement

Analytics

Value-based care

Bachelor's degree

Education

Bachelor's degree

Master's degree (preferred)

Job description

Humana, Inc. is seeking a Value-Based Programs Lead to support Medicaid VBP initiatives and provider relationships. You will drive end-to-end operational support for specialty VBP models and work toward path-to-value goals across markets.

The role requires 5+ years in managed care operations, provider reimbursement and analytics, plus 2+ years designing VBP strategies for specialty providers. This remote role may require up to 10% travel, with 40-hour weeks aligned to EST.