Value-Based Programs Lead – VBP Design

🕒 2 dias atrás

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $104.000 - $143.000 / ano

⏰ Tempo Integral

🟠 Sênior

✍️ Designer

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Humana

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1961

🏥 Saúde

🛡️ Seguros

⚕️ Seguro de Saúde

Healthcare • Insurance • Healthcare Insurance

A Humana é uma empresa de saúde dedicada a gerar um impacto positivo na saúde de indivíduos, comunidades e do sistema de saúde como um todo. Com foco em colocar a saúde em primeiro lugar, a Humana atende a uma ampla e diversa gama de populações, incluindo idosos e militares, oferecendo planos Medicare Advantage (HMO, PPO e PFFS). A Humana está comprometida em promover uma cultura de pertencimento e respeito mútuo, oferecendo benefícios competitivos e flexíveis para garantir a segurança financeira de seus funcionários e de suas famílias. A empresa se orgulha de criar um ambiente de trabalho inclusivo, no qual todos têm a oportunidade de ter sucesso.

Descrição

• 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

🎯 Requisitos

• 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

🏖️ Benefícios

• 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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