Location: This position will work a hybrid model (remote and in office one day per week). Ideal candidates will live within 50 miles of one of our Pulse Point locations in Norfolk, VA, Woburn, MA, Indianapolis, IN, Atlanta, GA, Richmond, VA, Mason, OH, Portland, ME, Chicago, IL, Wallingford, CT, Louisville, KY, Wilmington, DE, Tampa, FL or Nashville, TN.
The Provider Contract Cost of Care Consultant Senior is responsible for providing the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider network satisfaction.
How you will make an impact:
Provides expert advice, analytic and consultative support to Medical Directors and Management on cost of care issues.
Leads large scale initiatives with high dollar cost savings opportunities.
Partners with provider contractors to develop contracting strategy and supports all aspects of the contract negotiation process.
Works with multiple provider types including the most complex, high-profile providers.
Supports a full range of contract arrangements and pricing mechanisms including the most complex contract terms.
Works complex, large-scale enterprise-wide initiatives and acts as project lead.
Uses analytic tools to track both health risks and compliance, as well as supporting the contract negotiation process.
Performs healthcare cost analysis to identify strategies to control costs.
Projects cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis.
Prepares complex pre-negotiation analyses to support development of defensible pricing strategies.
Researches the financial profitability/stability and competitive environment of providers to determine impact of proposed rates.
Projects different cost of savings targets based upon various analytics.
Identifies cost of care savings opportunities by analyzing practice patterns in relation to office visits, referral practices, and specialty care procedures and recommends policy changes and claim's system changes to pursue cost savings.
Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable.
Recommends standardized practices to optimize cost of care.
Educates provider contractors on contracting analytics from a financial impact perspective.
Recommends alternative contract language and may go on-site to provider premises during contract negotiations.
Leads the research on provider's financial profitability/stability and competitive environment to determine impact of proposed rates.
Communicates fee strategies to manage provider expectations.
Provides on-going analytic and consultative support during complex and the most intense provider negotiations.
Educates provider contractors on contracting analytics from a financial impact perspective.
Recommends alternative contract language.
Acts as a source of direction, training and guidance for less experienced staff.
Looks for continuous quality improvements and finds better ways to accomplish end results.
Works side by side with their manager.
Minimum Requirements:
Requires BA/BS degree in Mathematics, Statistics or related field and a minimum of 7 years' experience in broad-based analytical, managed care payor or provider environment as well as in depth experience in statistical analysis and modeling; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences:
Expertise with Snowflake strongly preferred.
Expertise in SQL, with the ability to manipulate large datasets strongly preferred.
Advanced in SAS, PowerPoint, Tableau, Power BI, and Excel strongly preferred.
Previous health insurance experience strongly preferred.
Independent and self-motivated capable of performing with minimal supervision strongly preferred.
Quick learner willing to take ownership of their tasks strongly preferred.
Demonstrated teamwork skills and the ability to collaborate effectively with both teammates and provider groups strongly preferred.
Experience providing leadership in evaluating and analyzing complex initiatives preferred.
Master's degree preferred.
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.
