Value-Based Programs Lead (VBP Design)

Humana

8h•$104,000 - $143,000•Remote

About The Position

Humana Healthy Horizons is seeking a Value-Based Programs Lead to support successful value-based provider relationships, improve the provider experience, and achieve path-to-value goals. The role leads end-to-end operational support for specialty Medicaid value-based payment (VBP) models in alignment with segment strategy and goals. The lead serves as a VBP subject matter expert with advanced technical knowledge and experience, translating strategy into models that can be piloted and scaled across markets. The position develops VBP models for provider types including behavioral health, maternity, specialists, and social determinants of health, and creates glide paths that help providers move from volume-based to value-based arrangements. It aligns model-development work with the roadmap and Medicaid contractual requirements and RFP commitments. The role analyzes financial, utilization, quality, and performance data; designs payment strategies, model logic, performance metrics, benchmarks, and financial terms; and partners with finance on impact analysis and modeling. The lead also helps develop provider reporting packages, works with matrixed teams to operationalize and roll out models, addresses operational gaps, and monitors performance KPIs to identify opportunities to improve model design. This is a remote position, with up to 10% travel potentially required for onsite meetings. Typical hours are Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Time, with 40 scheduled weekly hours. The stated starting pay range is $104,000–$143,000 per year, and the role is eligible for a performance-based bonus incentive plan.

Requirements

Bachelor's degree.
At least five years of experience in managed care operations, provider reimbursement and analytics, and value-based care.
At least two years of direct experience designing, structuring, and implementing 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 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 working in a matrixed environment.
Expertise in Medicare and/or Medicaid managed care.
Ability to identify, structure, and solve complex business problems.
Excellent interpersonal, organizational, written, oral communication, and presentation skills, including proven experience writing and delivering presentations to management team members.
Ability to meet the work-at-home requirements: self-provided internet with at least 25 Mbps download and 10 Mbps upload speed, and a dedicated workspace without ongoing interruptions to protect member PHI/HIPAA information.

Nice To Haves

Master's degree.
Expertise in VBP financial modeling and impact analysis.
Direct experience working for a Medicaid managed care health plan.

Responsibilities

Develop innovative VBP models for provider types such as behavioral health, maternity, specialists, and social determinants of health, including glide paths that move providers from volume to value.
Align the scope of work for new VBP model development with the roadmap, Medicaid contractual requirements, and RFP commitments.
Analyze financial, utilization, quality, and performance data to identify opportunities to improve quality and/or reduce total cost of care.
Create VBP payment strategies and model designs, including payment logic, performance metrics and benchmarks, and financial terms aligned with segment goals.
Design and contribute to provider reporting packages that explain overall and detailed provider performance.
Partner with the finance team to conduct impact analyses and modeling for new VBP models.
Collaborate with team members and matrixed teams to operationalize and roll out new VBP models, and contribute to solutions for operational gaps.
Monitor VBP model performance KPIs and use internal and external feedback and performance data to identify opportunities to enhance model design.
Translate strategy into VBP models that can be piloted and scaled across markets.