Value-Based Programs Lead (VBP Design)

Become a part of our caring community

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.

Required Qualifications

Bachelor's degree.

Minimum five (5) years of experience in managed care operations, provider reimbursement and analytics, and value-based care.

Two (2) or more years of direct experience designing, structuring, and implementing value-based payment (VBP) strategies and models for specialty providers, including pay-for-performance, bundled payments, accountable care, shared savings, and shared-risk arrangements.

Experience using financial, utilization, quality, and performance data to directly design and model VBP arrangements, including establishing baselines and benchmarks, identifying cost and utilization opportunities, setting performance targets, and developing incentive, shared-savings, and risk methodologies.

Experience operating in matrixed environment.

Expertise in Medicare and/or Medicaid managed care.

Ability to identify, structure and solve complex business problems.

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.

Direct experience working for a Medicaid managed care health plan.

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).

Work at Home Requirements: 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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.