Value-Based Programs Lead
At Humana, caring is everything. You look after our members and patients. We look after you. If caring means something to you too, we’ve got a spot for you. We design competitive and flexible benefits packages to provide our employees a sense of financial security now and in the future.
Fostering a culture of inclusion is part of the fabric of who we are. We must have a workplace that reflects the people we serve and thrives in part because every person can bring their whole self to work to do their best work. Our vibrant, diverse culture and environment of inclusion is one of our greatest strengths.
About Humana Healthy Horizons
Humana Healthy Horizons is more than a health plan. We’re human care. Humana Healthy Horizons focuses on helping people achieve their best health. Our dedicated strategies across various markets and states are enabled by partnerships with state and local governments, community-based organizations, and national partners committed to removing barriers to helping people achieve their best health.
Humana Healthy Horizons is seeking a Value-Based Programs(VBP) Lead who will support successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. This position will be responsible for leading the beginning-to-end operational support of specialty Medicaid value-based payment (VBP) models in alignment with segment strategy and goals.
- Develops new innovative VBP models for 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.
- Aligns scope of work with roadmap for new VBP model development to ensure compliance with Medicaid contractual requirements and RFP commitments.
- Analyzes financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care.
- Creates VBP payment strategies and model design, such as developing payment model logic, performance metrics and benchmarks, and financial terms, which align with segment goals.
- Designs and contributes to development of provider reporting packages to help providers understand their overall and detailed performance.
- Partners with finance team to conduct impact analysis and modeling for new VBP models.
- Collaborates with team members and matrixed teams to operationalize and rollout of new VBP models.
- Contributes to developing solutions for operational gaps.
- Monitors VBP model performance KPIs to identify opportunities to enhance model design based on internal and external feedback and performance data.
- Translates strategy into models that can be piloted and scaled across markets.
- Bachelor’s Degree.
- Minimum of three (3) 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 Medicaid and 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.
- Proven experiences writing and delivering presentations to members of a management team.
- Master’s Degree.
- Expertise in VBP financial modeling and impact analysis.
- Workstyle: This is a remote position
- Workdays & Hours: Monday – Friday; Eastern Standard Time (EST) with some flexibility.
- Travel: Up to 10% possibly outside of your state of residence.
Work at Home Criteria
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
- At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
- Satellite, cellular and microwave connection can be used only if approved by leadership.
- Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
- Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
- Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Scheduled Weekly Hours40
Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$102,200 - $140,700 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.