[Remote] Senior Value-Based Programs Professional at Humana

San Antonio, Texas, United States

Apply Now

Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, MedicaidIndustries

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
Highly adept at managing processes from concept to completion ensuring on-time, on-budget, and on-target results
Ability to identify, structure and solve business problems
Excellent interpersonal, organizational, written, and oral communication and presentation skills

Responsibilities

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

Skills

Key technologies and capabilities for this role

Value-Based ProgramsMedicaidData AnalysisBusiness Review MeetingsStrategic ConsultationPerformance InsightsContract ComplianceStakeholder CoordinationMarket SupportVBP Models

Questions & Answers

Common questions about this position

What is the salary range for this Senior Value-Based Programs Professional position?

This information is not specified in the job description.

Is this a remote position or does it require office work?

This information is not specified in the job description.

What are the required qualifications for this role?

A Bachelor’s Degree and 3-5 years of experience at a health plan value-based programs are required.

What is the company culture like at Humana for this role?

Humana emphasizes becoming part of a caring community to help put health first.

What makes a strong candidate for this position?

Candidates with a Bachelor’s Degree and 3-5 years of experience in health plan value-based programs, along with skills in data analysis, project management, and facilitating cross-functional teams, stand out.

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.

Land your dream remote job 3x faster with AI

Try Jobo Free