Value-Based Programs Lead – VBP Design
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Job Description
VBP Lead designing specialty Medicaid payment models for Humana, a U.S. healthcare insurer. Analyzing performance data and scaling value-based provider programs.
Responsibilities:
- Support successful value-based provider relationships, focusing on provider experience and path-to-value goals
- Lead end-to-end operational support of specialty Medicaid value-based payment models
- Develop innovative VBP models for behavioral health, maternity, specialty providers, and social determinants of health
- Create glide paths to move providers from volume to value
- Align new VBP model development with segment roadmaps, Medicaid contractual requirements, and RFP commitments
- Analyze financial, utilization, and performance data to identify quality improvement and total-cost-of-care reduction opportunities
- Create VBP payment strategies and model designs, including payment logic, performance metrics, benchmarks, and financial terms
- Design and contribute to provider reporting packages explaining overall and detailed performance
- Partner with finance on impact analysis and modeling for new VBP models
- Collaborate with matrixed teams to operationalize and roll out new VBP models
- Identify and help resolve operational gaps
- Monitor VBP model performance KPIs and enhance model design using feedback and performance data
- Translate strategy into models that can be piloted and scaled across markets
Requirements:
- Bachelor's degree
- Minimum five (5) years of experience in managed care operations, provider reimbursement and analytics, and value-based care
- Two (2) or more years of direct experience designing, structuring, and implementing value-based payment (VBP) strategies and models for specialty providers
- Experience with pay-for-performance, bundled payments, accountable care, shared savings, and shared-risk arrangements
- Experience using financial, utilization, quality, and performance data to design and model VBP arrangements
- Experience establishing baselines and benchmarks, identifying cost and utilization opportunities, setting performance targets, and developing incentive, shared-savings, and risk methodologies
- Experience operating in a matrixed environment
- Expertise in Medicare and/or Medicaid managed care
- Ability to identify, structure, and solve complex business problems
- Excellent interpersonal, organizational, written, and oral communication and presentation skills
- Proven experience writing and delivering presentations to members of the management team
- Preferred: Master's degree
- Preferred: Expertise in VBP financial modeling and impact analysis
- Preferred: Direct experience working for a Medicaid managed care health plan
- Ability to work remotely from a dedicated space without ongoing interruptions
- Home internet with minimum download speed of 25 Mbps and upload speed of 10 Mbps
Benefits:
- Bonus incentive plan based on company and/or individual performance
- Medical, dental, and vision benefits
- 401(k) retirement savings plan
- Paid time off
- Company and personal holidays
- Paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Remote work arrangement
- Up to 10% travel for onsite meetings
- Dedicated home workspace and internet requirements supporting remote work
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