Value-Based Programs Lead (Medicaid)

Humana; United States; Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Bonus incentive plan

Comprehensive benefits

Job summary

Humana is seeking a Value-Based Programs Lead to support end-to-end operational management of Medicaid VBP models and provider relationships. You will drive model design, reporting, and analytical insight to improve quality and manage total cost of care.

The role requires 5+ years in managed care, VBP strategy, and Medicare/Medicaid expertise, with strong communication skills. This remote position may require up to 10% travel and is aligned with EST business hours.

Qualifications

• Bachelor’s degree is required.
• 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 (pay for performance, bundles, ACO, shared savings and risk).
• Expertise in Medicare and/or Medicaid managed care.
• Ability to analyze financial, utilization, and performance data.
• Ability to identify, structure and solve complex business problems.
• Experience in a matrixed environment.
• Excellent interpersonal, organizational, written, and oral communication and presentation skills.

Responsibilities

• Develop new innovative VBP models for provider types (behavioral health, maternity, specialists, SDOH).
• Align scope of work with roadmap for VBP model development.
• Analyze financial, utilization, and performance data to drive quality and cost improvements.
• Create VBP payment strategies and model design with metrics and terms.
• Design provider reporting packages to explain performance.
• Partner with finance for impact analysis and modeling of new VBP models.
• Collaborate across teams to operationalize and roll out VBP models.
• Monitor VBP KPIs and refine model design based on feedback.

Skills

Financial data analysis

Problem solving

Communication skills

Matrixed environment experience

Presentation skills

Education

Bachelor’s degree

Master’s degree (preferred)

Job description

Become a part of our caring community

Humana Healthy Horizons is looking for a Value-Based Programs Lead who will support successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. You will lead the beginning-to-end operational support of specialty Medicaid value-based payment (VBP) models in alignment with segment strategy and goals. The Value-Based Programs Lead will be a subject matter expert in VBP and have advanced technical knowledge and experience.

• 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.

Use your skills to make an impact

Required 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.

Preferred Qualifications

• Master’s degree.
• Expertise in VBP financial modeling and impact analysis.

Additional Information

• Workstyle: This is a remote position.
• Travel: This role may require up to 10% travel for onsite meetings, which could include locations outside your state of residence.
• Typical Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana’s offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education certifications, etc.

$104,000 - $143,000 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 12-21-2026

About usAbout Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.