Value-Based Care Programs Leader

Humana, Inc.; Santa Fe (NM); Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Medical, dental and vision benefits

401(k) retirement savings plan

Paid time off and holidays

Job summary

Humana Healthy Horizons seeks a Value-Based Programs Lead to support successful value-based provider relationships and improve the provider experience while achieving path-to-value goals.

You will oversee end-to-end operational support of Medicaid value-based payment models, aligning with strategy and applying expert VBP knowledge to design payment models, reporting, and performance analytics.

Qualifications

• Five years in managed care operations, provider reimbursement and analytics, and value-based care.
• Two or more years designing, structuring and implementing value-based payment strategies for specialty providers.
• Experience using data to model VBP arrangements 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.
• Excellent interpersonal, organizational, written, and oral communication and presentation skills.

Responsibilities

• Develop new innovative VBP models for providers including behavioral health, maternity, and social determinants.
• Align scope of work with roadmap for new VBP model development and Medicaid requirements.
• Analyze financial, utilization, and performance data to drive quality improvements and reduce cost of care.
• Create VBP payment strategies and model design with metrics, benchmarks and incentives.
• Design provider reporting packages to help understand performance.
• Collaborate with finance to conduct impact analysis and modeling for new VBP models.
• Work with matrixed teams to operationalize and rollout new VBP models and address gaps.
• Monitor VBP KPIs to refine model design based on feedback and data.
• Translate strategy into pilot-ready models scalable across markets.

Skills

Managed care operations

Provider reimbursement

Analytics

Value-based care

Communication skills

Presentation skills

Interpersonal skills

Education

Bachelor's degree

Master's degree

Job description

Humana Healthy Horizons seeks a Value-Based Programs Lead to support successful value-based provider relationships and improve the provider experience while achieving path-to-value goals.

You will oversee end-to-end operational support of Medicaid value-based payment models, aligning with strategy and applying expert VBP knowledge to design payment models, reporting, and performance analytics.