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

Humana Healthy Horizons is seeking a Senior Value-Based Programs professional who will support 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. Successful candidates will have an in-depth knowledge of VBP and have advanced technical knowledge and experience.

• Administers new innovative VBP 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.
• Analyzes financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care.
• Scorecard creation and reconciliation of provider performance based on contractual terms.
• Analyzes utilization data to reconcile provider disputes.
• Contributes to development and support of provider reporting packages to help providers understand their overall performance.
• Collaborates with cross functional and matrixed teams to operationalize and rollout new VBP models.

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s Degree.
• Three (3) or more years of experience in managed care operations, provider reimbursement and analytics and/or value-based care.
• In-depth knowledge of VBP model support or similar reimbursement model designs including analyzing provider performance, reporting, and scorecard/reconciliation reporting.
• Understanding of Medicaid and/or Medicaid managed care.
• Ability to understand and analyze financial, utilization, and performance data.
• Ability to identify, structure and solve moderately 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. 

Preferred Qualifications

• Expertise in VBP financial modeling and impact analysis.
• Experience performing claims data analysis to inform VBP provider performance.
• Experience in SQL, SAS, PowerBI and/or Tableau.

Additional Information

• Workstyle: This is a Remote position that will require minimal travel possibly outside of your state of residence for face-to-face meetings and collaborations.
• Typical Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST).

Work at Home Internet Statement

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees 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
• Employees 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 employees 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 for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$76,800 - $105,800 per year

 

This job is eligible for a bonus incentive plan.