Value-Based Programs Lead

San Antonio, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

Candidates must have at least 3 years of experience with provider performance management and/or value-based contracting. A strong understanding of key value-based financial components, including revenue drivers, expense components, benefit, and sales processes is required. Experience working with senior leadership, facilitating cross-departmental projects, and strong communication and presentation skills are essential. Project management experience on mid to large-scale projects is also necessary, along with a flexible and dynamic personality that works well in a team environment. Preferred qualifications include working knowledge of Service Fund reports, an advanced degree, and experience with data extraction and analysis technologies.

Responsibilities

The Value-Based Programs Lead will support national value-based provider relationships, focusing on improving the provider experience, performance, and achieving path-to-value goals. This role involves providing strategic advice and guidance to functional teams and working with senior executives to develop and drive segment or enterprise-wide functional strategies with key national value-based provider partners. Responsibilities include advising market executives on functional strategies for provider contracting and performance management, consulting on and leading the internal and external provider engagement strategy, and leading national joint operating committees. The lead will also possess a solid understanding of how organization capabilities interrelate across departments and build templates, standard documentation, and disseminate best-in-class knowledge.

Skills

provider performance management

value-based contracting

revenue drivers

DOFR (expense) components

benefit process

sales process

cross-functional project management

communication

presentation

project management

data extraction

data analysis

Service Fund reports

templates

provider contracting

performance management

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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