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Company

Humana · 3 days ago

Value-Based Programs Lead

United States

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

Develop new innovative Value Based Program 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.

Qualification

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Value-Based Payment (VBP) modelsManaged care operationsProvider reimbursementMedicaid managed careFinancial modelingImpact analysisData analysisVBP model designPerformance metricsMatrixed environment experience

Required

Bachelor’s degree

5+ years of experience in managed care operations, provider reimbursement and analytics, and value-based care

Successfully demonstrated experience in VBP model design and strategy with specialty providers, including pay for performance, bundles, accountable care, and shared savings and risk models.

2 + years’ experience in 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

Occasionally travel for meetings due to business needs

Preferred

Master’s degree.

Expertise in VBP financial modeling and impact analysis

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

Represents job field similar to this job

Trends of Total Sponsorships

2023 (217)

2022 (257)

2021 (258)

2020 (107)