Value- Programs Lead; Medicaid Strategy

Position: Value-Based Programs Lead (Medicaid Strategy)
** Become a part of our caring community*
* The Value-Based Programs Lead (Medicaid Strategy) supports successful value-based provider relationships with a focus on improving the provider's experience and achieving path-to-value goals. The Value-Based Programs Lead provides strategic advice and guidance to functional team(s).

The Value-Based (VB) Programs Lead (Medicaid Strategy) will advise senior leadership on Medicaid segment strategy that delivers upon segment cost, quality, and provider advancement goals. You will also support Medicaid Request for Proposals (RFPs) by developing market-specific VB strategy, commitments, and provider partnerships that contribute to winning proposals that expand existing and new business. We ask that you have an in-depth understanding of value-based programs, experience setting strategy, and ability to analyze data from multiple sources.

You will leverage available VB outcomes, trends, and quality data, competitive insights, and regulatory information to inform strategy. You will work on problems of diverse scope and moderate to substantial complexity, necessitating advanced technical knowledge and understanding of VB programs.

** Key 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 sun setting 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.

** Use your skills to make an impact*
* ** Required Qualifications*
* + 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.

** Preferred Qualifications*
* +

Experience with Medicaid managed care.

** Additional Information*
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** Workstyle:
** This is a remote position.

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** Travel:
** This role may require up to 10% travel for onsite meetings, which could include locations outside your state of residence.

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** Typical Workdays and

Hours:

** Monday - Friday; 8:00am - 5:00pm Eastern Standard Time (EST).

** WAH Internet Statement*
* 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.

+ 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.

** Interview Format*
* As part of our hiring process for this opportunity, we will be using an…