Value-Based Programs Lead

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