Director, Medicaid Value Based Payment Solutions (Remote optional) | Humana



The Director, Medicaid Value-Based Payment Solutions will be responsible for leading the development, evolution, and performance of Humana Healthy Horizon’s (Medicaid) value-based payment (VBP) model portfolio. This senior level leader will oversee a team of direct reports to design, implement, administer, and evaluate Medicaid VBP models to drive improved provider experience and achievement of path-to-value goals. The Director, Medicaid Value-Based Payment Solutions requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

Key Responsibilities


  • Identify opportunities and design strategies to improve quality outcomes and reduce overall cost of care using business analytics, quality metrics, and claims data.
  • Develop and implement new innovative VBP models for range of provider types, including behavioral health, maternity, specialists, and PCPs, creating glide paths to move providers from volume to value
  • Guide VBP model design, including performance metrics and benchmarks, reporting packages, and financial terms.
  • Oversee administration of Medicaid specialty VBP models, including provider reporting packages, settlements/reconciliations, and provider educational materials and tools
  • Consult on negotiations of PCP risk arrangement terms
  • Oversee implementation of VBP models in new markets, including developing key business rules and establishing standard processes.
  • 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.
  • Partner with finance team to conduct impact analysis and modeling for new and existing VBP models
  • 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
  • Establish and maintain standard operating procedures and policies to guide team work
  • Effectively manage team of direct reports

Required Qualifications

  • Bachelor’s Degree
  • 7+ years of experience in managed care operations, provider reimbursement and analytics, and value-based care
  • 4+ years progressive leadership experience hiring, training, and managing associates
  • Expertise in VBP model design, financial modeling, operations, and contracting strategies
  • Ability to understand and analyze financial, utilization, and performance data
  • Passion for people development and demonstrated leadership success (both internally and externally)
  • Ability to identify, structure and solve complex business problems
  • 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

  • Master’s degree
  • Expertise in Medicaid and Medicaid managed care
  • Experience performing claims data analysis to inform VBP model design
  • Experience designing and administering specialty VBP models (e.g., behavioral health, maternity)

Additional Information

  • For this job, associates are required to be fully COVID vaccinated, including booster or undergo weekly COVID testing and wear a face covering while at work. The weekly testing will need to be done through an approved Humana vendor, and unvaccinated associates should follow all social distancing and masking protocols if they are required to come into a Humana facility or work outside of their home. We are a healthcare company committed to putting health and safety first for our members, patients, associates, and the communities we serve.

If progressed to offer, you will be required to:

  • Provide proof of full vaccination, including booster or commit to testing protocols OR  
  • Provide proof of applicable exemption including any required supporting documentation
  • Medical, religious, state and remote-only work exemptions are available.

Scheduled Weekly Hours



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