Associate Director, Medicaid Value Based Payment Solutions - Humana
Tallahassee, FL
About the Job
Become a part of our caring community and help us put health first
The Associate Director, Value-Based Solutions will be responsible for leading the operational performance of Humana Healthy Horizon's specialty value-based payment (VBP) model portfolio. The Associate Director will oversee a team of direct reports to implement operational processes, administer, and evaluate Medicaid VBP models to drive improved provider experience and achievement of path-to-value goals. This role requires an in-depth understanding of how organizational capabilities interrelate across the function or segment.
Key Responsibilities:
+ Oversee administration of Medicaid specialty VBP models, including provider reporting packages, settlements/reconciliations, and provider facing tools
+ Collaborate with matrixed corporate and market teams, including provider services, finance, analytics, and contracting, to operationalize VBP models and ensure alignment of VBP models with enterprise strategies.
+ Consult on negotiations of specialty VBP model terms.
+ Analyze financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care.
+ Monitor VBP model performance KPIs to identify opportunities to enhance model design based on internal and external feedback and performance data.
+ Partner with finance team to conduct impact analysis and modeling for new and existing VBP models.
+ Ensure data integrity in program administration for new value-based program.
+ Troubleshoot data integrity issues and offer solutions to solve challenges.
+ Manage VBP portfolio to KPIs agreed upon with senior leaders. Present regularly to senior leaders on progress and performance.
+ Drive positive experiences and performance among participating providers.
+ Accountable for establishing annual team goals and priority initiatives in alignment with leadership and enterprise goals and ensuring strong team performance.
+ Establish and maintain standard operating procedures and policies to guide team members' work and improve efficiencies.
+ Provides day to day leadership of direct reports, as well as regular job performance feedback.
+ Supports team members in their development and ensures positive work environment that promotes associate retention and high quality, timely products.
Use your skills to make an impact
Required Qualifications
+ Bachelor's Degree
+ 5+ years experience in managed care operations, provider reimbursement and analytics, and value-based care
+ 3+ years progressive leadership experience hiring, training, and managing associates
+ Expertise in VBP financial modeling and operations
+ Ability to understand and analyze financial, utilization, and performance data
+ Passion for people development and demonstrated leadership success (both internally and externally)
+ Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of the management team.
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
+ Masters Degree
+ Expertise in Medicaid and Medicare managed care
+ Expertise performing claims data analysis to inform VBP model design
+ Experience administering specialty VBP models (E.g., behavior health, maternity, LTSS, etc.)
+ Experience with tools for creating data visualizations
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 Humana@myworkday.com 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:
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
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.$112,400 - $154,900 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
The Associate Director, Value-Based Solutions will be responsible for leading the operational performance of Humana Healthy Horizon's specialty value-based payment (VBP) model portfolio. The Associate Director will oversee a team of direct reports to implement operational processes, administer, and evaluate Medicaid VBP models to drive improved provider experience and achievement of path-to-value goals. This role requires an in-depth understanding of how organizational capabilities interrelate across the function or segment.
Key Responsibilities:
+ Oversee administration of Medicaid specialty VBP models, including provider reporting packages, settlements/reconciliations, and provider facing tools
+ Collaborate with matrixed corporate and market teams, including provider services, finance, analytics, and contracting, to operationalize VBP models and ensure alignment of VBP models with enterprise strategies.
+ Consult on negotiations of specialty VBP model terms.
+ Analyze financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care.
+ Monitor VBP model performance KPIs to identify opportunities to enhance model design based on internal and external feedback and performance data.
+ Partner with finance team to conduct impact analysis and modeling for new and existing VBP models.
+ Ensure data integrity in program administration for new value-based program.
+ Troubleshoot data integrity issues and offer solutions to solve challenges.
+ Manage VBP portfolio to KPIs agreed upon with senior leaders. Present regularly to senior leaders on progress and performance.
+ Drive positive experiences and performance among participating providers.
+ Accountable for establishing annual team goals and priority initiatives in alignment with leadership and enterprise goals and ensuring strong team performance.
+ Establish and maintain standard operating procedures and policies to guide team members' work and improve efficiencies.
+ Provides day to day leadership of direct reports, as well as regular job performance feedback.
+ Supports team members in their development and ensures positive work environment that promotes associate retention and high quality, timely products.
Use your skills to make an impact
Required Qualifications
+ Bachelor's Degree
+ 5+ years experience in managed care operations, provider reimbursement and analytics, and value-based care
+ 3+ years progressive leadership experience hiring, training, and managing associates
+ Expertise in VBP financial modeling and operations
+ Ability to understand and analyze financial, utilization, and performance data
+ Passion for people development and demonstrated leadership success (both internally and externally)
+ Excellent interpersonal, organizational, written, and oral communication and presentation skills with proven experience writing and delivering presentations to members of the management team.
+ Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Preferred Qualifications
+ Masters Degree
+ Expertise in Medicaid and Medicare managed care
+ Expertise performing claims data analysis to inform VBP model design
+ Experience administering specialty VBP models (E.g., behavior health, maternity, LTSS, etc.)
+ Experience with tools for creating data visualizations
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 Humana@myworkday.com 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:
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
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.$112,400 - $154,900 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, 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, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Source : Humana