Value-Based Programs Lead — Remote, Medicaid VBP Innovation

Humana Inc; Salt Lake City (UT); Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Remote position

Travel up to 10%

40-hour work week (EST)

Job summary

Humana Healthy Horizons seeks a Value-Based Programs Lead to advance Medicaid value-based payment models and strengthen provider relationships across specialties. You will design, pilot and scale VBP strategies, analyze financial and performance data, and collaborate with finance and operations to improve quality and total cost of care.

The role requires translating strategy into scalable models and working across matrixed teams to implement pilots in multiple markets.

Qualifications

• Bachelor's degree required.
• Minimum 5 years in managed care operations, provider reimbursement and analytics, and value-based care.
• Expertise in VBP design and strategy with specialty providers including pay for performance, bundles, accountable care and shared savings.
• Experience with Medicare and/or Medicaid managed care.
• Ability to analyze financial, utilization and performance data.
• Ability to solve complex business problems and operate in a matrixed environment.
• Strong written and oral communication and presentation skills for senior leadership.

Responsibilities

• Develop new innovative VBP models for various provider types (behavioral health, maternity, specialists, social determinants of health).
• Align scope of work with roadmap and ensure Medicaid contractual and RFP alignment.
• Analyze data to identify opportunities to improve quality and reduce total cost of care.
• Design VBP payment strategies, model logic, metrics and financial terms.
• Create provider reporting packages to show performance.
• Collaborate with finance for impact analysis and modeling.
• Partner with teams to operationalize and rollout VBP models.
• Monitor KPIs and adapt model design based on feedback and data.
• Translate strategy into pilots scalable across markets.

Skills

VBP model design

data analytics

provider reimbursement

healthcare operations

stakeholder management

Education

Bachelor's degree

Master's degree (preferred)

Job description

Humana Healthy Horizons seeks a Value-Based Programs Lead to advance Medicaid value-based payment models and strengthen provider relationships across specialties. You will design, pilot and scale VBP strategies, analyze financial and performance data, and collaborate with finance and operations to improve quality and total cost of care.

The role requires translating strategy into scalable models and working across matrixed teams to implement pilots in multiple markets.