Value-Based Contracting Lead

Become a part of our caring community and help us put health first
 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.

• 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
 

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.

$104,000 - $143,000 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.Application Deadline: 01-30-2025
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.