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The Medicaid Value Based Contracts Lead is responsible for ensuring Medicaid Value-Based Payment (VBP) models are effectively translated into letters and contract templates, developing internal and provider facing educational materials, managing non-standard language and financial terms processes, and supporting contractors through VBP amendment negotiation processes. This important role serves as the subject matter expert on Medicaid VBP, partnering effectively within the team, with Medicaid markets, and with cross-functional business partners involved in Medicaid VBP contract development, operational set-up, and execution. The Value Based Contracting Lead requires in-depth understanding of VBP and the contracting process to support value based programs, effective communication, and ability to develop processes and identify solutions to solve problems.
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Role Overview
- Serve as Medicaid subject matter expert in VBP contract template development process
- Partner with cross-functional teams to ensure new contract templates are developed in necessary time frames based on project plan due dates
- Work with VBP model designers to ensure all model operational impacts have been cared for and are effectively translated into VBP contract templates
- Receive and review provider initiated redlines to identify operational feasibility and impacts; if the redlines are not acceptable, propose alternative language that contractors can use
- Coordinates review of non-standard financial terms with Medicaid VBP leadership and Medicaid Market Finance
- Work with network operations teams to ensure executed VBP amendments are loaded correctly into Humana systems
- Manage internal contract repository for Medicaid VBP Operations team to use to ensure contracts are administered in accordance with agreed upon terms
- Develop provider letters outlining program details and terms
- Develop internal and provider-facing educational materials about each model
- Manage all enterprise approval processes and senior level presentations, including Humana’s VSBAC committee and internal approval process for provider-facing and external educational materials and letters in compliance with company policies
- Communicates program overview including contract terms, payment structures, and payment rates to market contractors and providers
- Collaborates with cross-functional areas to educate and align on VBP programs
- Ensuring tasks and responsibilities are completed in necessary time to meet deadline
Use your skills to make an impact
Required Qualifications
- Bachelor’s Degree
- 5 or more years of VBP program development, contracting or contract template development experience at a health insurance company
- 2+ years’ experience in VBP model structure, design, and/or operations
- Proficiency in analyzing, understanding and communicating financial impact of contract terms, payment structures and reimbursement rates to providers
- Experience in negotiating managed care contracts with primary physician groups or other specialty providers
- Excellent written and verbal communication skills and experience presenting to varied audiences
- Ability to manage multiple priorities in a fast-paced environment
- Knowledge of Microsoft Office applications (Word, Excel, Power Point, Teams)
- Must be passionate about contributing to an organization focused on continuously improving consumer experiences
- Occasionally travel for meetings due to business needs
Preferred Qualifications
- Expertise in Medicaid Value-Based Payment Models
- Master's Degree
Work-At-Home Requirements
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates 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
- Associates 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 associates 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, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.
If you are selected to move forward from your application prescreen, you will receive an email correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. (please be sure to check your spam or junk folders often to ensure communication isn’t missed) If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.
If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.
Social Security Number Statement
Humana value's 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 [email protected] with instructions on how to add the information into your official application on Humana’s secure website.
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 year
This 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 veteran status. 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.
What We Do
At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.
