Description
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 end-to-end 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 improvement.
- Create VBP payment strategies and model design, including payment model logic, performance metrics, and benchmarks.
- Design and contribute to development of provider reporting packages.
- Partner with finance team to conduct impact analysis and modeling for new VBP models.
- Collaborate with team members and matrixed teams 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.
- Expertise in VBP model design and strategy with specialty providers.
- Expertise in Medicare and/or Medicaid managed care.
- Ability to understand and analyze financial, utilization, and performance data.
- Excellent interpersonal, organizational, written, and oral communication skills.
Preferred qualifications:
- Master's degree.
- Expertise in VBP financial modeling and impact analysis.
Additional information:
- Remote position.
- Up to 10% travel for onsite meetings.
- Typical workdays and hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
Benefits:
- Competitive benefits supporting whole-person well-being, including medical, dental, and vision benefits, 401(k) retirement savings plan, time off, and more.