Value-Based Contracting Lead

Humana • Trenton, NJ

397d • Hybrid

About The Position

The Medicaid Value Based Contracting Lead is responsible for translating Medicaid Value-Based Payment (VBP) models into contract templates and educational materials, managing financial terms processes, and supporting contractors during VBP negotiations. This role serves as a subject matter expert in Medicaid VBP, collaborating with various teams to ensure effective contract development and execution.

Requirements

• 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 and communicating financial impacts of contract terms
• Experience in negotiating managed care contracts with primary physician groups or specialty providers
• Excellent written and verbal communication skills
• Ability to manage multiple priorities in a fast-paced environment
• Knowledge of Microsoft Office applications (Word, Excel, Power Point, Teams)
• Passion for improving consumer experiences

Nice To Haves

• Expertise in Medicaid Value-Based Payment Models
• Master's Degree

Responsibilities

• Serve as Medicaid subject matter expert in VBP contract template development process
• Partner with cross-functional teams to ensure timely development of new contract templates
• Work with VBP model designers to translate operational impacts into VBP contract templates
• Review provider-initiated redlines for operational feasibility and propose alternative language if necessary
• Coordinate review of non-standard financial terms with Medicaid VBP leadership and Finance
• Ensure executed VBP amendments are correctly loaded into Humana systems
• Manage internal contract repository for Medicaid VBP Operations team
• Develop provider letters outlining program details and terms
• Create internal and provider-facing educational materials about each model
• Manage enterprise approval processes and senior level presentations
• Communicate program overview including contract terms and payment structures to contractors and providers
• Collaborate with cross-functional areas to educate on VBP programs
• Ensure tasks are completed on time to meet deadlines

Benefits

• Health insurance
• 401k
• Paid holidays
• Flexible scheduling
• Professional development opportunities

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED