Louisville, Kentucky-based Humana is a leading healthcare company that offers a variety of health, wellness, and insurance products and services designed to off
Value-Based Programs Lead
Location
EST (UTC-5)
Posted
10 days ago
Salary
$104K - $143K / year
Seniority
Lead
No structured requirement data.
Job Description
Value-Based Programs Lead
Humana
Role Description Humana Healthy Horizons is looking for a Value-Based Programs Lead who will support successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. You will lead 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. - Develop new innovative VBP models for a 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. - Create 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. 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 Medicare and/or 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. Requirements - Master's degree (Preferred). - Expertise in VBP financial modeling and impact analysis (Preferred). Benefits - Medical, dental and 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. - Many other opportunities. Company Description Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it.
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