Value-Based Programs Lead (Medicaid)

Location: Remote nationwide within the United States; occasional travel to hirify.global offices or onsite meetings may be required, including outside the employee’s state of residence. Working hours are Monday–Friday, 8:00am–5:00pm EST.

Salary: $104,000–$143,000 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare and insurance company serving members through Medicare, Medicaid, insurance services, and healthcare services.

What you will do

• Develop and scale value-based payment models for behavioral health, maternity, specialty providers, and social determinants of health.
• Design payment logic, performance metrics, benchmarks, financial terms, and provider reporting packages.
• Analyze financial, utilization, and performance data to improve quality and reduce total cost of care.
• Partner with finance on impact analysis and modeling for new value-based programs.
• Coordinate matrixed teams to operationalize and roll out new models while addressing operational gaps.
• Monitor KPIs and use provider feedback and performance data to improve model design.

Requirements

• Bachelor’s degree.
• At least five years of experience in managed care operations, provider reimbursement and analytics, and value-based care.
• Expertise in value-based payment model design for specialty providers, including pay for performance, bundled payments, accountable care, shared savings, and risk models.
• Expertise in Medicare and/or Medicaid managed care.
• Ability to analyze financial, utilization, and performance data and solve complex business problems.
• Strong communication and presentation skills, including experience presenting to management in a matrixed environment.

Nice to have

• Master’s degree.
• Expertise in value-based payment financial modeling and impact analysis.

Culture & Benefits

• Remote work with occasional travel for training, meetings, or onsite sessions.
• Dedicated workspace and reliable home internet are required to protect member PHI and HIPAA information; minimum speeds are 25 Mbps download and 10 Mbps upload.
• Medical, dental, and vision coverage.
• 401(k), paid time off, company and personal holidays, and paid parental and caregiver leave.
• Disability and life insurance, wellness support, and bonus incentive eligibility.