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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 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.
Creation of 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.
Use your skills to make an impact
Required 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.
Preferred Qualifications
Master's degree.
Expertise in VBP financial modeling and impact analysis.
Additional Information
Workstyle: This is a remote position.
Travel: This role may require up to 10% travel for onsite meetings, which could include locations outside your state of residence.
Typical Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).
Scheduled Weekly Hours
40Pay Range
The 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 will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
Description of Benefits
Humana, 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 10-01-2026
About us
About Humana: 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. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.