at Humana in Dover, Delaware, United States
Become a part of our caring community and help us put health first Why Humana?
At Humana, caring is everything. You look after our members and patients. We look after you. If caring means something to you too, we've got a spot for you. We design competitive and flexible benefits packages to provide our employees a sense of financial security now and in the future.
Fostering a culture of inclusion is part of the fabric of who we are. We must have a workplace that reflects the people we serve and thrives in part because every person can bring their whole self to work to do their best work. Our vibrant, diverse culture and environment of inclusion is one of our greatest strengths.
About Humana Healthy Horizons
Humana Healthy Horizons is more than a health plan. We're human care. Humana Healthy Horizons focuses on helping people achieve their best health. Our dedicated strategies across various markets and states are enabled by partnerships with state and local governments, community-based organizations, and national partners committed to removing barriers to helping people achieve their best health.
+ Develop new innovative VBP models for range of provider types, such as behavioral health, maternity, specialists, and social determinants of health, creating glide paths to move providers from volume to value.
+ Align scope of work with roadmap for new VBP model development to ensure compliance with Medicaid contractual requirements and RFP commitments.
+ Analyze financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care.
+ Creation of VBP payment strategies and model design, such as developing payment model logic, performance metrics and benchmarks, and financial terms, which align with segment goals.
+ Design and contribute to development of provider reporting packages to help providers understand their overall and detailed performance.
+ Partner with finance team to conduct impact analysis and modeling for new VBP models.
+ Collaborate with team members and matrixed teams to operationalize and rollout of new VBP models. Contribute to developing solutions to operational gaps.
+ Monitor VBP model performance KPIs to identify opportunities to enhance model design based on internal and external feedback and performance data.
+ Ability to translate strategy into models that can be piloted and scaled across markets.
Use your skills to make an impact Required Qualifications + Bachelor's degree.
+ Minimum 5 years of experience in managed care operations, provider reimbursement and analytics, and value-based care.
+ Expertise in VBP model design and strategy with specialty providers, including pay for performance, bundles, accountable care, and shared savings and risk models.
+ Expertise in Medicaid and Medicaid managed care.
+ Ability to understand and analyze financial, utilization, and performance data.
+ Ability to identify, structure and solve complex business problems.
+ Experience operating in matrixed environment.
+ Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of the management team.?
Additional Information + Workstyle: This is a remote position
+ Workdays & Hours: Monday – Friday; Eastern Standard Time ( EST ) with some flexibility.
+ Travel: Up to 10% possibly outside of your state of residence.
+ For candidates who live in Louisiana: Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department ( LDH ) who work directly with LDH's Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov) (
+ For candidates who live in Indiana: According to the Indiana Office of Inspector General Rule, 42 IAC 1-5-14 Post-Employment Restrictions, if you are a current or former state officer, employee or special state appointee with Indiana Family and Social Services Administration ( FSSA ) within the past year, engaged in the negotiation or the administration of a Medicaid contract on behalf of the state and/or Family and Social Services Administration ( FSSA ); in a position to make discretionary decision affecting the: (1) outcome of the negotiation; or (2) nature of the administration; or either engaged in making a regulatory or licensing decision that directly applied to Humana Inc. or to a parent or subsidiary you cannot be considered for this opportunity. For more information please visit: IG: Indiana Office of Inspector General ( Our Benefits Health benefits effective day 1. Humana offers a variety of benefits to promote the best health and well-being of our employees and their families. We design competitive and flexible packages to give our employees a sense of financial security-both today and in the future, including:
+ Paid time off, holidays, volunteer time and jury duty pay, Recognition pay.
+ 401(k) retirement savings plan with employer match.
+ Tuition assistance, Scholarships for eligible dependents.
+ Parental and caregiver leave.
+ Employee charity matching program.
+ Network Resource Groups (NRGs).
+ Career development opportunities.
Work at Home Criteria 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 recommended; wireless, wired cable or DSL connection is suggested.
+ Satellite, cellular and microwave connection can be used only if approved by leadership.
+ 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.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from with instructions on how to add the information into your official application on Humana's secure website.As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.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:
Scheduled Weekly Hours 40
Pay Range The 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.$102,200 – $140,700 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
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