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

Why Humana?

At Humana, caring is everything. You look after our members and patients. We look after you. If caring means something to you too, we’ve got a spot for you. We design competitive and flexible benefits packages to provide our employees a sense of financial security now and in the future.

Fostering a culture of inclusion is part of the fabric of who we are. We must have a workplace that reflects the people we serve and thrives in part because every person can bring their whole self to work to do their best work. Our vibrant, diverse culture and environment of inclusion is one of our greatest strengths.

About Humana Healthy Horizons

Humana Healthy Horizons is more than a health plan. We’re human care. Humana Healthy Horizons focuses on helping people achieve their best health. Our dedicated strategies across various markets and states are enabled by partnerships with state and local governments, community-based organizations, and national partners committed to removing barriers to helping people achieve their best health.

• Develop 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. 

• 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. 
• Minimum 5 years of experience in managed care operations, provider reimbursement and analytics, and value-based care. 
• Expertise in VBP model design and strategy with specialty providers, including pay for performance, bundles, accountable care, and shared savings and risk models. 
• Expertise in Medicaid and 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.  

Additional Information

• Workstyle: This is a remote position
• Workdays & Hours: Monday – Friday; Eastern Standard Time (EST) with some flexibility.
• Travel: Up to 10% possibly outside of your state of residence.
• For candidates who live in Louisiana: Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH’s Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)
• For candidates who live in Indiana: According to the Indiana Office of Inspector General Rule, 42 IAC 1-5-14 Post-Employment Restrictions, if you are a current or former state officer, employee or special state appointee with Indiana Family and Social Services Administration (FSSA) within the past year, engaged in the negotiation or the administration of a Medicaid contract on behalf of the state and/or Family and Social Services Administration (FSSA); in a position to make discretionary decision affecting the: (1) outcome of the negotiation; or (2) nature o