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Sr. Value-Based Programs Professional job in Bethesda at Humana

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Sr. Value-Based Programs Professional at Humana

Sr. Value-Based Programs Professional

Humana Bethesda, MD Full-Time


The Senior Value-Based Programs Professional supports successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. The Senior Value-Based Programs Professional works on problems of diverse scope and complexity ranging from moderate to substantial. Successful candidates will be subject matter experts in VBP and have advanced technical knowledge and experience.


The Senior Value-Based Programs Professional advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.

Key Responsibilities :

  • Develop new innovative VBP models for range of provider types, such as behavioral health, maternity, specialists, and social determinants of health, creating glide paths to move providers from volume to value

  • Align scope of work with roadmap for new VBP model development to ensure compliance with Medicaid contractual requirements and RFP commitments

  • Analyze financial, utilization, and performance data to identify opportunities to drive improvements in quality and/or reductions in total cost of care

  • Creation of VBP payment strategies and model design, such as developing payment model logic, performance metrics and benchmarks, and financial terms, which align with segment goals.

  • Design and contribute to development of provider reporting packages to help providers understand their overall and detailed performance

  • Partner with finance team to conduct impact analysis and modeling for new VBP models

  • Collaborate with team members and matrixed teams to operationalize and rollout of new VBP models. Contribute to developing solutions to operational gaps.

  • Monitor VBP model performance KPIs to identify opportunities to enhance model design based on internal and external feedback and performance data.

  • Ability to translate strategy into models that can be piloted and scaled across markets

Required Qualifications

  • Bachelor's Degree

  • 3-5 years of experience in managed care operations, provider reimbursement and analytics, and value-based care

  • Expertise in VBP model design and strategy with specialty providers, including pay for performance, bundles, accountable care, and shared savings and risk models

  • Ability to understand and analyze financial, utilization, and performance data

  • Ability to identify, structure and solve complex business problems

  • Experience operating in matrixed environment

  • 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 able to work in the CST or EST time zone

Preferred Qualifications

  • Expertise in Medicaid managed care

  • Expertise in VBP financial modeling and impact analysis

  • Experience in SQL, PowerBI and/or Tableau


Additional Information:

Vaccine Policy:

Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field. Every associate and contractor who work inside a Humana facility or in the field, regardless of vaccination status, must complete a daily health screening questionnaire.

Please note: Some areas of our business, such as the Primary Care Organization including CenterWell, Conviva, Kindred at Home, onehome, SeniorBridge, Neighborhood Centers, Pharmacy Distribution Centers and others, may be required to adhere to federal, state or local or additional workplace guidelines.

Work-At-Home Requirements:

  • WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.

  • A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required.

  • Satellite and Wireless Internet service is NOT allowed for this role.

  • A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Why Humana?

At Humana, we know your well-being is important to you, and it's important to us too. That's why we're committed to making resources available to you that will enable you to become happier, healthier, and more productive in all areas of your life. Just to name a few:

  • Work-Life Balance

  • Generous PTO package

  • Health benefits effective day 1

  • Annual Incentive Plan

  • 401K - Immediate company match

  • Well-being program

  • Paid Volunteer Time Off

  • Student Loan Refinancing

If you share our passion for helping people, we likely have the right place for you at Humana.

Social Security Task:

Alert: Humana values personal identity protection. Please be aware that applicants being considered for an interview will be asked to provide a social security number, if it is not already on file. When required, an email will be sent from [ Email address blocked ] - Click here to apply to Sr. Value-Based Programs Professional with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours


Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our [ Link removed ] - Click here to apply to Sr. Value-Based Programs Professional

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