Provider Contract / Cost of Care Consultant
Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.
Preferred Location: Virginia Beach, VA
The Provider Contract / Cost of Care Consultant is responsible for providing analytical support to the Cost of Care and/or Provider Contracting organizations.
How you will make an impact:
- Works with types of analyses include performing sophisticated retrospective data analytics
- Building new and modifying existing complex models to create predictive impact decision making tools
- Projecting cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis
- Preparing pre-negotiation analysis to support development of defensible pricing strategies
- Performing healthcare cost analysis to identify strategies to control costs
- Performing modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic; measuring and evaluating the cost impact of various negotiation
- Researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates,and 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, costs of services, provider patterns, and network use.
- Provides expert advice, analytic and consultative support, supports tool development, conducts trainings and outreach, and develops documentation.
- Partners with provider contractors, Tableau developers, and data base administrators to develop contracting tools and analytic reporting.
- Uses analytic tools to aid enterprise reporting and initiatives.
- Supports value-based reporting and consults with users and leadership in ensuring value-based projects are met.
- Acts as a source of direction, training, and guidance for less experienced staff.
- Conducts regular testing and develops recommendations on needed enhancements to tools and data.
- Ability to work independently and in a team setting.
- Leads training, presentations, and outreach to users, stakeholders, and leadership.
Requires BS/BA degree in Mathematics, Statistics, or related field; minimum of 5 years experience in broad-based analytical, managed care payor or provider environment; considerable experience in statistical analysis and healthcare modeling; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences:
- Master's degree preferred.
- Experience with SQL, SAS, Snowflake or Tableau and ability to manipulate large sets of data.
- Strong customer service, presenting, and communication skills.
- Experience of provider operational knowledge and claims.
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 firstname.lastname@example.org assistance.