Humana is hiring a Senior Value-Based Programs Professional to support successful value-based provider relationships with a focus on improving provider experience and achieving path-to-value goals. In this role, you will be responsible for leading beginning-to-end operational support of specialty Medicaid value-based payment (VBP) models.
What You'll Do
- Administer 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.
- Analyze financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care.
- Create and reconcile provider performance scorecards based on contractual terms.
- Analyze utilization data to reconcile provider disputes.
- Contribute to development and support of provider reporting packages to help providers understand their overall performance.
- Collaborate with cross functional and matrixed teams to operationalize and rollout new VBP models.
What We're Looking For
- Bachelor’s Degree.
- Three (3) or more years of experience in managed care operations, provider reimbursement and analytics and/or value-based care.
- In-depth knowledge of VBP model support or similar reimbursement model designs including analyzing provider performance, reporting, and scorecard/reconciliation reporting.
- Understanding of Medicaid and/or Medicaid managed care.
- Ability to understand and analyze financial, utilization, and performance data.
- Ability to identify, structure and solve moderately complex business problems.
- Experience operating in a 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.
Nice to Have
- Expertise in VBP financial modeling and impact analysis.
- Experience performing claims data analysis to inform VBP provider performance.
- Experience in SQL, SAS, PowerBI and/or Tableau.
Technical Stack
- SQL
- SAS
- PowerBI
- Tableau
Team & Environment
You will operate in a matrixed environment and collaborate with cross-functional teams.
Benefits & Compensation
- Compensation: $78,400 - $107,800 per year
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Bonus incentive plan based upon company and/or individual performance
Work Mode
This is a remote position.
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status.
