Value-Based Programs Lead

Humana Inc. · Remote Nationwide · $104,000 - $143,000 per year · remote Humana Healthy Horizons is seeking a Value-Based Programs Lead to support successful value-based provider relationships, focusing on improving the provider experience and achieving path-to-value goals. The Value-Based Programs Lead will lead the operational support of specialty Medicaid value-based payment (VBP) models, aligning with segment strategy and goals. This role requires advanced technical knowledge and experience in VBP. Key responsibilities: Develop innovative VBP models for various provider types, such as behavioral health, maternity, specialists, and social determinants of health 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 for quality improvements and cost reductions Create VBP payment strategies and model designs, including payment model logic, performance metrics, and financial terms Design and contribute to the development of provider reporting packages Partner with the finance team to conduct impact analysis and modeling for new VBP models Collaborate with team members to operationalize and rollout new VBP models Monitor VBP model performance KPIs to identify opportunities for enhancement Requirements: Bachelor's degree Minimum 5 years of experience in managed care operations, provider reimbursement and analytics, and value-based care 2+ 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 Expertise in Medicare and/or Medicaid managed care Excellent interpersonal, organizational, written, and oral communication skills Preferred qualifications: Master's degree Expertise in VBP financial modeling and impact analysis Direct experience working for a Medicaid managed care health plan Additional information: Remote position Up to 10% travel for onsite meetings Typical workdays and hours: Monday – Friday; 8:00am – 5:00pm EST Pay range: $104,000 - $143,000 per year Eligible for a bonus incentive plan Benefits: 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