Become a part of our caring community and help us put health first
 

The Sr. Value-Based Programs professional supports successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. This position will be responsible for leading the beginning-to-end operational support of specialty Medicaid value based payment (VBP) models in alignment with segment strategy and goals. Successful candidates will have an in-depth knowledge of VBP and have advanced technical knowledge and experience.

Key Responsibilities:

• Administer new innovative VBP models for 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
• Scorecard creation and reconciliation of provider performance 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.

Use your skills to make an impact
 

Required Qualifications:

• Bachelor’s Degree
• 3-5 years of experience in managed care operations, provider reimbursement and analytics, and value-based care
• In-depth knowledge of VBP model support 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 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. 
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Preferred Qualifications:

• 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

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$76,800 – $105,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides 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 and many other opportunities.

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and 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. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

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 because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.