Value Based Programs Lead in Nationwide

Become a part of our caring community Humana Healthy Horizons is looking for a Value-Based Programs Lead who will support successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. You will lead the beginning-to-end operational support of specialty Medicaid value-based payment (VBP) models in alignment with segment strategy and goals. The Value-Based Programs Lead will be a subject matter expert in VBP and have advanced technical knowledge and experience. 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. <

Become a part of our caring community Provides executive leadership to Humana. The Regional Chief Medical Officer (CMO) is an entrepreneurial & experienced physician leader committed to the principles of comprehensive primary care and unlocking the power of value-based care for patients at national scale. S/he will be a proven clinician, leader, and strategist capable of driving the highest standards of care, building high-performance care teams, developing clinical leadership talent, and quantifiably improving outcomes and performance across multiple geographies. The Regional CMO will directly lead a team of regional & area medical directors and serve as dyad partner to the Regional Market President for one of the Primary Care Organization’s regions across the nation where CenterWell and/or Conviva serve patients. The Regional CMO will report to the Chief Medical Officer of the Primary Care Organization. This role requires periodic travel to markets (40% or less) to meet with national and regional teams and should be based in one of our current or upcoming CenterWell or Conviva markets. Responsibilities Drive Clinical Excellence in Culture & Performance · Build a best-in-class culture of engaged clinicians, focused on patient-focused care and clinical excellence, where doing the right thing for patients and team-based care within a value-based care framework, drives success and pride · Drive patient outcomes and population impact across regions for optimal results, across patient care experience & engagement, disease prevalence, quality/STARS, efficiency of care, and improved clinical outcomes and utilization. · Identify and act on opportunities

Become a part of our caring community The Medical Director, National Outpatient Medicare leverages clinical expertise and medical judgment to review preauthorization requests for services. This role is responsible for evaluating moderately complex to complex cases, where analysis of clinical information and situational factors requires in-depth assessment and sound decision-making. As a Medical Director at Humana , you will use your clinical expertise and judgment to make meaningful coverage and care determinations that support quality, consistency, and compliance across the healthcare continuum. In this role, you will review requests for services, level of care, and site of service, using nationally recognized clinical guidelines, CMS policies, medical references, and internal clinical resources to guide decision-making. This position offers the opportunity to work on complex outpatient cases , review clinical documentation, and collaborate with both internal partners and external physicians to gather additional information and discuss determinations. You may also contribute to care management activities and, depending on the role, provide input on areas such as clinical documentation, coding, grievances and appeals, and outpatient services or equipment reviews. Beyond case review, this role provides the opportunity to build strong relationships with physicians, provider groups, facilities, and community partners in support of regional priorities. It is a strong fit for physicians who are interested in contributing to value-based care, population health, and care management strategies while working in a structured environment that values sound clinical judgment, collaboration, and operational excellence. Humana is seeking a Medical Director to

Become a part of our caring community Humana is seeking a Lead Product Manager, Medication Experience & Pharmacy Solutions to lead the strategy, discovery, delivery, and optimization of digital experiences that help members understand, manage, and maximize the value of their prescription benefits. This highly visible role sits at the intersection of pharmacy, health insurance, member experience, and digital product innovation. The Lead Product Manager will own the product lifecycle end-to-end, from identifying customer and business opportunities through defining features and stories, partnering across Design and Engineering, driving delivery, and measuring outcomes. Success requires strong strategic thinking, customer obsession, analytical rigor, and the ability to influence cross-functional stakeholders in a highly matrixed environment. The role directly supports Humana's goals of improving member experience, increasing digital engagement, reducing friction in medication-related journeys, and helping members make informed healthcare decisions. Why Join This Team This role offers a unique opportunity to solve meaningful healthcare problems at scale. You will help millions of members better understand their benefits, manage medications, reduce prescription costs, and make more informed healthcare decisions. Unlike many product organizations, our Product Managers own the entire product lifecycle, providing an uncommon level of ownership, accountability, and impact from strategy through implementation and measurement. Responsibilities Define and execute product strategy, vision, and roadmap for Medication Experience and Pharmacy Solutions Identify member, business, and operational opportunities through research, analytics, VOC, and stakeholder insights Lead product discovery efforts to validate problems, oppor

Become a part of our caring community Humana’s Product organization is seeking a Lead Product Manager to drive the strategy, development, and optimization of the Adobe Experience Platform (AEP) in support of Adobe Web Integrations for Authenticated and Unauthenticated Web Channels. In this role, you will serve as a key product leader responsible for translating business needs into platform capabilities that enable personalized, data-driven customer experiences. You’ll work closely with cross-functional teams to deliver scalable solutions across Real-Time CDP, Journey Optimizer, and Customer Journey Analytics. This role is focused on growing adoption and usage of Adobe Experience Platform as an enterprise platform while supporting and scaling capabilities to support Authenticated (MyH) and Unauthenticated ( H.com) driving dynamic, context-aware customer engagement on Web channels. Success in this role means partnering with key lines of business to translate requirements into detailed product features for engineering teams to enable, while building decisioning strategies that optimize customer outcomes and business value. Key Role Functions Product Strategy & Vision Collaboratively own and manage the product backlo