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.
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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
ALERT: Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana's secure website.
As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
Satellite, cellular and microwave connection can be used only if approved by leadership
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
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.