[Remote] Value-Based Programs Lead (Medicaid Strategy)

Note: The job is a remote job and is open to candidates in USA. Humana Inc. is a leading U.S. healthcare company seeking a Value-Based Programs Lead (Medicaid Strategy) to support value-based provider relationships and improve provider experiences. The role involves advising senior leadership on Medicaid strategy, developing market-specific strategies for Requests for Proposals (RFPs), and leveraging data to inform strategic decisions.

Responsibilities

• Use data to identify and develop solutions for opportunities to advance the Medicaid segment's VBP strategy and achieve quality, trend, and contractual priorities
• Lead VBP strategy development for 2-3 growth market Requests for Proposal (RFPs) per year. This includes, but is not limited to, conducting competitor research and gathering provider insights, aligning VB models with population health and quality priorities at Humana, and identifying partnership opportunities to strengthen proposal outcomes
• Collaborate with Medicaid Network and Network Strategy team to advise and support negotiations for VB provider contractual commitments ahead of RFP submissions
• Be the subject matter expert (SME) for VB strategy in Medicaid RFPs to ensure Humana's positioning is competitive and responsive to market requirements
• Evaluate and make recommendations on designing new, re-designing existing, and sunsetting VB models based on available Return on investment (ROI)/outcome, quality, and trend data to optimize the Medicaid VB portfolio
• Support VB Solution team's annual strategic planning process by contributing market insights and data-driven recommendations
• Conduct competitor research using previous RFPs and other industry sources to ensure Humana's VB strategy remains industry-leading and innovative
• Monitor national VB care trends/research and communicate relevant information to peers and stakeholders
• Lead VBP Annual Report content development
• Other responsibilities as assigned

Skills

• Bachelor's degree
• Five (5) or more years of experience in value-based care, preferably with a health plan
• Three (3) or more years of experience in a strategy advancement role
• Three (3) or more years of highly data-driven analytics experience, with a consistent focus on deeply analyzing and interpreting financial, quality, and utilization data to inform decision-making and drive outcomes
• Demonstrated ability to develop and execute strategies from concept through completion, delivering results on time, within budget, and aligned with objectives
• Ability to identify, structure, and solve complex business problems through analytical thinking and strategic decision-making
• Proven ability to communicate effectively with leadership teams, providing clear updates, insights, and recommendations to support strategic decision-making and organizational alignment
• Experience with Medicaid managed care

Benefits

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

Company Overview

Company H1B Sponsorship