Value-Based Programs Lead

Humana • Work at Home - Ohio, OH

1d • $104,000 - $143,000 • Remote

About The Position

The Value-Based Programs Lead supports successful value-based provider relationships in the Humana Healthy Horizons in Ohio (HHH-OH) market with a focus on improving the provider experience and achieving path-to-value goals. The Value-Based Programs Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Value-Based Programs Lead will play a key role in the implementation and support of key value-based care programs in the Ohio Medicaid Market. This role will be focused on the implementation and administration of significant Value Based Contracting (VBC) relationships in the Ohio Medicaid market.
The Value-Based Programs Lead advises executives to develop functional strategies (often segment specific) on matters of significance. Uses independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action. Requires little to no instruction on day-to-day work and general direction on more complex work. Leads others on development of methods and approach.
Presents Value-based programs to Providers and encourages participation to grow Humana Healthy Horizon in Ohio's value-based footprint.
Leads the design and / or redesign of VBC programs.
Oversees and coordinates the VBC implementation pipeline for Humana Medicaid National programs in Ohio.
Develops and improves processes as needed to provide governance of ODM-required (Ohio Department of Medicaid) VBC programs.
Advises Ohio Network executive leadership on VBC progress for Humana Healthy Horizons Ohio through the development of executive summaries and state-required strategy documents.
Collaborates with corporate and market partners with input on the design of value-based payment programs and operational reporting.

Requirements

• Bachelor's Degree or equivalent experience.
• Minimum three (3) years of experience in valued-based care, network contracting, network operations and/or network development or equivalent.
• Proven expertise in driving management of timelines and processes.
• Ability to identify, structure and solve complex business problems.
• Experience operating in matrixed environment.

Nice To Haves

• Master's Degree.
• Experience working with the ODM contracting requirements.
• Understanding of Ohio Medicaid contractual requirements, Ohio Administrative and Revised Codes, and provider landscape.
• Expertise in value-based payment models.

Responsibilities

• Presents Value-based programs to Providers and encourages participation to grow Humana Healthy Horizon in Ohio's value-based footprint.
• Leads the design and / or redesign of VBC programs.
• Oversees and coordinates the VBC implementation pipeline for Humana Medicaid National programs in Ohio.
• Develops and improves processes as needed to provide governance of ODM-required (Ohio Department of Medicaid) VBC programs.
• Advises Ohio Network executive leadership on VBC progress for Humana Healthy Horizons Ohio through the development of executive summaries and state-required strategy documents.
• Collaborates with corporate and market partners with input on the design of value-based payment programs and operational reporting.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior