Value-Based Programs Lead - Medicaid
$104k - $143k/yr+ Bonus incentive plan
Senior
Bachelor's, Master's
Remote in USA
RemoteUp to 10% travel for onsite meetings; occasional travel to Humana offices may be required. Must work Eastern Standard Time hours (8:00 a.m.–5:00 p.m.).
Business & StrategyBusiness Operations
About the job
Requirements
- A bachelor's degree is required.
- A minimum of 5 years of experience in managed care operations, provider reimbursement and analytics, and value-based care is required.
- Expertise in value-based payment model design and strategy with specialty providers, including pay for performance, bundles, accountable care, and shared savings and risk models, is required.
- Expertise in Medicare and/or Medicaid managed care is required.
- Ability to understand and analyze financial, utilization, and performance data is required.
- Ability to identify, structure, and solve complex business problems is required.
- Experience operating in a matrixed environment is required.
- Interpersonal, organizational, written, oral communication, and presentation skills are required, including experience writing and delivering presentations to members of the management team.
Responsibilities
- Support successful value-based provider relationships, focusing on improving provider experience and achieving path-to-value goals.
- Lead end-to-end operational support of specialty Medicaid value-based payment models in alignment with segment strategy and goals.
- Develop innovative value-based payment models for provider types including behavioral health, maternity, specialists, and social determinants of health, creating glide paths to move providers from volume to value.
- Align the scope of work with the roadmap for new value-based payment model development to ensure compliance with Medicaid contractual requirements and request for proposal commitments.
- Analyze financial, utilization, and performance data to identify opportunities to improve quality and/or reduce total cost of care.
- Create value-based payment strategies and model designs, including payment model logic, performance metrics and benchmarks, and financial terms aligned with segment goals.
- Design and contribute to the development of provider reporting packages to help providers understand their overall and detailed performance.
- Partner with the finance team to conduct impact analysis and modeling for new value-based payment models.
- Collaborate with team members and matrixed teams to operationalize and roll out new value-based payment models; contribute to solutions for operational gaps.
- Monitor value-based payment model performance key performance indicators to identify opportunities to enhance model design based on internal and external feedback and performance data.
- Translate strategy into models that can be piloted and scaled across markets.
Desired Qualifications
- A master's degree is preferred.
- Expertise in value-based payment financial modeling and impact analysis is preferred.
About the company
Humana sells health insurance paid for by government programs, chiefly Medicare Advantage plans that private insurers run for Americans 65 and older in place of traditional Medicare. It ranks among the largest Medicare Advantage insurers in the country and also runs Medicaid plans for low-income families in several states. Its CenterWell business operates senior primary care clinics, a mail-order pharmacy and home health services, so many members get care from a company the insurer owns. Medicare and states pay Humana a set monthly amount per member, and it keeps the difference between those payments and members' medical costs. Humana was founded in 1961 as a nursing home company and is based in Louisville, Kentucky.
Company Size
10,001+
Company Stage
IPO
Headquarters
Louisville, Kentucky
Founded
1961
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Simplify's Take
What believers are saying
- Enrollment is surging: in July 2026 Humana affirmed about 25% individual Medicare Advantage membership growth for 2026.
- Owned clinics create clinical careers: CenterWell Senior Primary Care added 130,900 patients, up 27%, in early 2026.
- Medicaid is widening: Illinois chose Humana in June 2026 to run Medicaid coverage statewide.
What critics are saying
- Low quality scores cut Medicare bonuses: only 20% of Humana's members sat in 4-star or better plans for 2026.
- The insurer is shrinking to save margins: about 600,000 Medicare Advantage members got plan-closure notices in October 2026.
- Stock grants carry risk: in July 2026 Humana cut its 2026 GAAP earnings floor to $6.52 a share from $8.36.
What makes Humana unique
- Military families are a second market: Humana runs the Pentagon's TRICARE health plan across 24 eastern states and Washington, DC.
- Florida anchors the business: Humana's Medicare Advantage contracts there produced 14% of its 2025 revenue.
- Medicaid is a quiet second insurer: Humana covers over 1.54 million low-income members across 11 states.
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Benefits
- Health Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Disability Insurance
- Unlimited Paid Time Off
- Paid Vacation
- Paid Parental Leave
- Short-term Disability
- Long-term Disability
- 401(k) Retirement Plan
- 401(k) Company Match