Value-Based Programs Lead – Medicaid Strategy

🕒 June 17

🇺🇸 United States – Remote

💵 $104k - $143k / year

⏰ Full Time

🟠 Senior

🧐 Strategy

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

⚕️ Healthcare Insurance

Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Supports successful value-based provider relationships with a focus on improving the provider's experience and achieving path-to-value goals. • Provides strategic advice and guidance to functional team(s). • Advises senior leadership on Medicaid segment strategy that delivers upon segment cost, quality, and provider advancement goals. • Supports Medicaid Request for Proposals (RFPs) by developing market-specific VB strategy, commitments, and provider partnerships. • Uses data to identify and develop solutions for opportunities to advance the Medicaid segment's VBP strategy and achieve quality, trend, and contractual priorities. • Leads VBP strategy development for 2-3 growth market Requests for Proposal (RFPs) per year. • Collaborates with Medicaid Network and Network Strategy team to advise and support negotiations for VB provider contractual commitments ahead of RFP submissions. • Evaluates and makes recommendations on designing new, re-designing existing, and sunsetting VB models based on available Return on investment (ROI)/outcome, quality, and trend data to optimize the Medicaid VB portfolio. • Conducts competitor research using previous RFPs and other industry sources to ensure Humana's VB strategy remains industry-leading and innovative. • Monitors national VB care trends/research and communicates relevant information to peers and stakeholders.

🎯 Requirements

• Bachelor's degree • Five (5) or more years of experience in value-based care, preferably with a health plan • Three (3) or more years of experience in a strategy advancement role • Three (3) or more years of highly data-driven analytics experience, with a consistent focus on deeply analyzing and interpreting financial, quality, and utilization data to inform decision-making and drive outcomes. • Demonstrated ability to develop and execute strategies from concept through completion, delivering results on time, within budget, and aligned with objectives • Ability to identify, structure, and solve complex business problems through analytical thinking and strategic decision-making • Proven ability to communicate effectively with leadership teams, providing clear updates, insights, and recommendations to support strategic decision-making and organizational alignment.

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave) • short-term and long-term disability • life insurance