The Value-Based Programs Lead supports successful value-based provider relationships in the Humana Healthy Horizons in Ohio (HHH-OH) market with a focus on improving the provider experience and achieving path-to-value goals. The Value-Based Programs Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Value-Based Programs Lead will play a key role in the implementation and support of key value-based care programs in the Ohio Medicaid Market. This role will be focused on the implementation and administration of significant Value Based Contracting (VBC) relationships in the Ohio Medicaid market.
- The Value-Based Programs Lead advises executives to develop functional strategies (often segment specific) on matters of significance. Uses independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, uses independent judgment requiring analysis of variable factors and determining the best course of action. Requires little to no instruction on day-to-day work and general direction on more complex work. Leads others on development of methods and approach.
- Presents Value-based programs to Providers and encourages participation to grow Humana Healthy Horizon in Ohio's value-based footprint.
- Leads the design and / or redesign of VBC programs.
- Oversees and coordinates the VBC implementation pipeline for Humana Medicaid National programs in Ohio.
- Develops and improves processes as needed to provide governance of ODM-required (Ohio Department of Medicaid) VBC programs.
- Advises Ohio Network executive leadership on VBC progress for Humana Healthy Horizons Ohio through the development of executive summaries and state-required strategy documents.
- Collaborates with corporate and market partners with input on the design of value-based payment programs and operational reporting.
Use your skills to make an impact Required Qualifications- Bachelor's Degree or equivalent experience.
- Minimum three (3) years of experience in valued-based care, network contracting, network operations and/or network development or equivalent.
- Proven expertise in driving management of timelines and processes.
- Ability to identify, structure and solve complex business problems.
- Experience operating in matrixed environment.
Preferred Qualifications- Master's Degree.
- Experience working with the ODM contracting requirements.
- Understanding of Ohio Medicaid contractual requirements, Ohio Administrative and Revised Codes, and provider landscape.
- Expertise in value-based payment models.
Additional InformationWork at Home Requirements: 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 required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours40
Pay RangeThe 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.
$104,000 - $143,000 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of BenefitsHumana, 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
