VBP Strategy & Model Lead

Humana, Inc.; City of Albany (NY); Remote; USD 104,000 - 143,000; Full time

Benefits offered by this job

Remote position

Up to 10% travel

40-hour workweek

Job summary

Humana Healthy Horizons is seeking a Value-Based Programs Lead to drive end-to-end operational support for specialty Medicaid VBP models. You will design payment strategies, model logic, and performance metrics while aligning with Medicaid requirements and contracts.

The role requires 5+ years in managed care operations and VBP design, with experience in Medicare/Medicaid, matrixed environments, and strong communication skills. Remote work with occasional travel is offered, plus a bonus plan.

Qualifications

• Minimum five (5) years of experience in managed care operations, provider reimbursement and analytics, and value-based care.
• Two (2) or more years of direct experience designing, structuring, and implementing VBP strategies and models for specialty providers.
• Experience using financial, utilization, quality, and performance data to design and model VBP arrangements.
• Experience operating in a matrixed environment.
• Expertise in Medicare and/or Medicaid managed care.
• Excellent interpersonal, organizational, written, and oral communication and presentation skills.

Responsibilities

• Lead end-to-end operational support of specialty Medicaid value-based payment (VBP) models.
• Develop new innovative VBP models for various provider types (behavioral health, maternity, specialists, social determinants of health).
• Align scope of work with roadmap to ensure Medicaid contractual compliance and RFP commitments.
• Analyze financial, utilization and performance data to identify opportunities to improve quality or reduce cost of care.
• Design VBP payment strategies and model design with aligned performance metrics and terms.
• Develop provider reporting packages to help understand performance.
• Partner with finance for impact analysis and modeling of new VBP models.
• Collaborate with teams to rollout and operationalize VBP models and close gaps.
• Monitor VBP KPIs and refine model design based on feedback and data.
• Translate strategy into piloted and scalable models across markets.

Skills

VBP design

Pay-for-performance

Bundled payments

Accountable care

Shared savings

Shared-risk

Education

Bachelor's degree

Job description

Humana Healthy Horizons is seeking a Value-Based Programs Lead to drive end-to-end operational support for specialty Medicaid VBP models. You will design payment strategies, model logic, and performance metrics while aligning with Medicaid requirements and contracts.

The role requires 5+ years in managed care operations and VBP design, with experience in Medicare/Medicaid, matrixed environments, and strong communication skills. Remote work with occasional travel is offered, plus a bonus plan.