[Hiring] Value-Based Programs Lead @Humana

Role Description

Humana Healthy Horizons is looking for a Value-Based Programs Lead who will support successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. You will lead the beginning-to-end operational support of specialty Medicaid value-based payment (VBP) models in alignment with segment strategy and goals. The Value-Based Programs Lead will be a subject matter expert in VBP and have advanced technical knowledge and experience.

• Develop new innovative VBP models for a range of provider types, such as behavioral health, maternity, specialists, and social determinants of health, creating glide paths to move providers from volume to value.
• 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 to drive improvements in quality and/or reductions in total cost of care.
• Create VBP payment strategies and model design, such as developing payment model logic, performance metrics and benchmarks, and financial terms, which align with segment goals.
• Design and contribute to development of provider reporting packages to help providers understand their overall and detailed performance.
• 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 of new VBP models. Contribute to developing solutions to operational gaps.
• Monitor VBP model performance KPIs to identify opportunities to enhance model design based on internal and external feedback and performance data.
• Ability to translate strategy into models that can be piloted and scaled across markets.

Qualifications

• 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, including pay for performance, bundles, accountable care, and shared savings and risk models.
• Expertise in Medicare and/or Medicaid managed care.
• Ability to understand and analyze financial, utilization, and performance data.
• Ability to identify, structure and solve complex business problems.
• Experience operating in matrixed environment.
• Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of the management team.

Requirements

• Master's degree (Preferred).
• Expertise in VBP financial modeling and impact analysis (Preferred).

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.
• Many other opportunities.

Company Description

Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.