Value-Based Programs Lead - Medicaid VBP & Innovation

Humana Inc; Juneau (AK); On-site; USD 104,000 - 143,000; Full time

Job summary

Humana Inc. is seeking a Value-Based Programs Lead to drive end-to-end operational support of Medicaid value-based payment models and to strengthen provider relationships.

You will develop VBP models across behavioral health, maternity, and specialists, align with Medicaid requirements, analyze financial and utilization data, and design reporting to help providers understand performance while partnering with finance to model impact. Remote, with up to 10% travel.

Qualifications

• Bachelor's degree required.
• Minimum 5 years in managed care operations, provider reimbursement and analytics.
• Expertise in VBP model design and strategy with specialty providers.
• 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.

Responsibilities

• Develop new VBP models for a range of provider types (behavioral health, maternity, specialists, SDOH).
• Align scope of work with roadmap to ensure Medicaid contractual requirements and RFP commitments.
• Analyze financial, utilization, and performance data to identify opportunities to improve quality and/or reduce cost of care.
• Create VBP payment strategies and model design with metrics, benchmarks, and financial terms.
• Design provider reporting packages to help providers understand overall and detailed 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 close gaps.
• Monitor VBP model KPIs and iterate designs based on feedback.

Skills

VBP model design

Data analytics

Provider reimbursement

Managed care operations

Education

Bachelor's degree

Master's degree

Job description

Humana Inc. is seeking a Value-Based Programs Lead to drive end-to-end operational support of Medicaid value-based payment models and to strengthen provider relationships.

You will develop VBP models across behavioral health, maternity, and specialists, align with Medicaid requirements, analyze financial and utilization data, and design reporting to help providers understand performance while partnering with finance to model impact. Remote, with up to 10% travel.