Become a part of our caring community and help us put health first
 

The Value-Based Programs Lead supports successful value-based provider relationships with a focus on
improving the provider experience and achieving path-to-value goals. This position will be responsible
for leading the beginning-to-end operational support of specialty Medicaid value-based payment (VBP)
models in alignment with segment strategy and goals. The Value-Based Programs Lead will be a subject
matter expert in VBP and have advanced technical knowledge and experience.

Role Overview

• 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.

Use your skills to make an impact
 

Required Qualifications

• 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 Qualifications

• Master’s degree.
• Expertise in VBP financial modeling and impact analysis

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
• Satellite, cellular and microwave connection can be used only if approved by leadership
• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
• Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Interview Format

As part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor.  This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.

If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn’t missed) If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.

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