[Remote] Senior Value-Based Programs Professional at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

N/AIndustries

Requirements

Bachelor’s Degree
3-5 years of experience at a health plan value-based care and/or provider engagement
3+ years experience in roles that involve reviewing and analyzing financial, quality, and utilization data and analytics
2+ years of project management experience
Past experience in a role that required delivery of excellent customer service
Ability to identify, structure and solve business problems
Excellent interpersonal, organizational, written, and oral communication and presentation skills
Experience with Medicaid managed care (Preferred)

Responsibilities

Responsible for end to end market support for assigned Medicaid markets to ensure markets achieve their VBP contract requirements and market goals
Facilitate Quarterly Business Review Meetings (QBR) with assigned market leaders to provide updates on VBP model performance, answer questions and resolve issues, consult on VBP strategy and provider targets, and ensure timely decision making on VBP model rollout or changes
Prepare for QBR meetings, including reviewing and analyzing of data, to ensure effective calls
Consult with market on VBP strategy to ensure compliance with contractual requirements and market goals
Provide data driven insights on market performance in each active VBP model
Research and answer market or provider questions on VBP models
Facilitate annual trainings for contracting, PR, PE, and other market staff on upcoming year VBP models and any changes
Work with markets to facilitate timely decision making on new VBP models or changes to existing VBP models
Coordinate internally with Medicaid VBP model design, contracting, and operations and analytics teams to prepare for and manage rollout of new VB models or changes to existing models
Manage rollout of new VBP models or changes to VBP models, including coordinating with Medicaid VBP design, operations, and analytic colleagues and enterprise teams
Convene matrixed operational partners to solve for operational gaps/barriers
Lead on time new market implementations of year 1 Medicaid VBP models and related contract requirements, including developing and maintaining project plans, facilitating implementation meetings, driving decisions on VBP model payouts and metrics, and developing provider-facing and associate trainings
Partner with cross functional and matrixed teams to drive key operational decisions, oversee implementation progress and milestones, and other project management functions
Support onboarding of market Network Optimization team, including their responsibilities for driving market VBP strategy and responsibilities of the corporate Medicaid VBP team
Advise Medicaid market leaders on year 1 VBP model timing and rollout strategy
Drive new market implementation readiness review material development

Skills

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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