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About the role
- Provider Contract/Cost of Care Consultant Senior supporting cost savings initiatives in healthcare at Elevance Health. Providing analytical support to improve quality of care and network satisfaction.
Responsibilities
- Provides the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations
- Focuses efforts on lowering claims costs, improving quality of care, and increasing member and provider network satisfaction
- 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 on the most complex, large scale enterprise-wide initiatives and acts as project lead
- Acts as a strategic partner to management
- Uses analytic tools to track both health risks and compliance, as well as supporting the contract negotiation process
- Performs sophisticated retrospective data analytics
- Develops the most complex new models and modifies existing models to create predictive impact decision making tools
- 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
- Performs modeling to compare various contract scenarios based on member utilization patterns and 'what if'
- Researches the financial profitability/stability and competitive environment of providers to determine the impact of proposed rates
- Recommends modifications as applicable
- Recommends standardized practices to optimize cost of care
- Educates provider contractors on contracting analytics from a financial impact perspective
- Communicates fee strategies to manage provider expectations
- Provides on-going analytic and consultative support during complex negotiations
- Acts as a source of direction, training and guidance for less experienced staff.
Requirements
- Requires BA/BS degree in Mathematics, Statistics or related field
- Minimum of 7 years of experience in broad-based analytical, managed care payor or provider environment
- In depth experience in statistical analysis and modeling
- Master's degree preferred
- Experience providing leadership in evaluating and analyzing complex initiatives preferred
- Cost of care analysis knowledge preferred
- Proficiency in data manipulation tools such as SQL, SAS, or similar preferred
- Exceptional analytical, organizational, presentation, and problem-solving skills preferred
- Provider contract knowledge preferred
- Medicare Group Retiree experience preferred.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Tech skills
Location requirements
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