52 applicants

Company

Humana · 10 hours ago

Value-Based Contracting Lead

Remote Nationwide

Full-time

Remote

Senior Level

$102K/yr - $141K/yr

5+ years exp

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Health CareHealth Insurance

H1B Sponsor Likely

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Responsibilities

Serve as Medicaid subject matter expert in VBP contract template development process

Partner with cross-functional teams to ensure new contract templates are developed in necessary time frames based on project plan due dates

Work with VBP model designers to ensure all model operational impacts have been cared for and are effectively translated into VBP contract templates

Receive and review provider initiated redlines to identify operational feasibility and impacts; if the redlines are not acceptable, propose alternative language that contractors can use

Coordinates review of non-standard financial terms with Medicaid VBP leadership and Medicaid Market Finance

Work with network operations teams to ensure executed VBP amendments are loaded correctly into Humana systems

Manage internal contract repository for Medicaid VBP Operations team to use to ensure contracts are administered in accordance with agreed upon terms

Develop provider letters outlining program details and terms

Develop internal and provider-facing educational materials about each model

Manage all enterprise approval processes and senior level presentations, including Humana’s VSBAC committee and internal approval process for provider-facing and external educational materials and letters in compliance with company policies

Communicates program overview including contract terms, payment structures, and payment rates to market contractors and providers

Collaborates with cross-functional areas to educate and align on VBP programs

Ensuring tasks and responsibilities are completed in necessary time to meet deadline

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

VBP program developmentContract template developmentNegotiating managed care contractsFinancial impact analysisMedicaid Value-Based Payment ModelsEducational material developmentMicrosoft OfficeManaging multiple priorities

Required

Bachelor’s Degree

5 or more years of VBP program development, contracting or contract template development experience at a health insurance company

2+ years’ experience in VBP model structure, design, and/or operations

Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers

Experience in negotiating managed care contracts with primary physician groups or other specialty providers

Excellent written and verbal communication skills and experience presenting to varied audiences

Ability to manage multiple priorities in a fast-paced environment

Knowledge of Microsoft Office applications (Word, Excel, Power Point, Teams)

Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Occasionally travel for meetings due to business needs

Preferred

Expertise in Medicaid Value-Based Payment Models

Master's Degree

Benefits

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

Company

Humana

Glassdoor

3.8

Humana is a health insurance provider for individuals, families, and businesses.

Founded in 1964

Louisville, Kentucky, USA

10,001+ employees

http://www.humana.com

H1B Sponsorship

Humana has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

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Trends of Total Sponsorships

2023 (217)

2022 (257)

2021 (258)

2020 (107)