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Prov Contract/CofC Consult

  • Job Family: Analytics
  • Type: Full time
  • Date Posted:
  • Req #: JR18428

Location:

  • Virginia, Virginia
  • Iowa, Iowa
  • Texas, Texas
  • Louisiana, Louisiana
  • Minnesota, Minnesota
  • Tennessee, Tennessee
  • Georgia, Georgia
  • South Carolina, South Carolina
  • Michigan, Michigan
  • Ohio, Ohio
  • Rhode Island, Rhode Island
  • Kentucky, Kentucky
  • Arkansas, Arkansas
  • North Dakota, North Dakota
  • New Jersey, New Jersey
  • Florida, Florida
  • New Hampshire, New Hampshire
  • New York, New York
  • Kansas, Kansas
  • Delaware, Delaware
  • Arizona, Arizona
  • Nevada, Nevada
  • Massachusetts, Massachusetts
  • Wyoming, Wyoming
  • Nebraska, Nebraska
  • Illinois, Illinois
  • Montana, Montana
  • California, California
  • Idaho, Idaho
  • North Carolina, North Carolina
  • Alabama, Alabama
  • Wisconsin, Wisconsin
  • Pennsylvania, Pennsylvania
  • Missouri, Missouri
  • Maryland, Maryland
  • Connecticut, Connecticut
  • Oregon, Oregon
  • Mississippi, Mississippi
  • Oklahoma, Oklahoma
  • Maine, Maine

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Description

Job Descriptions: External

Location: Remote

Hours: M-F 8-5pm Standard Hours

Provides 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. Provides expert advice, analytic and consultative support to Medical Directors and management on cost of care issues. Works on large scale initiatives with high dollar cost savings opportunities. Consults with business partners throughout the organization.  Analyzes large data sets to answer complex business problems.  Familiar with multiple provider types, including physician, ancillary, medical groups, and hospitals.  Works on complex enterprise-wide initiatives and acts as project lead. Primary duties may include, but are not limited to:

  • Uses analytic tools to track both health risks and compliance, as well as supporting the contract negotiation process.
  • Types of analyses include performing sophisticated retrospective data analytics; building new and modifying existing complex models to create predictive impact decision making tools; performing healthcare cost analysis to identify strategies to control costs; performing modeling to compare various scenarios based on provider practice patterns and nationally accepted clinical guidelines; 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, referral practices, and specialty care procedures.
  • Recommends policy changes to highlight high-quality, cost-efficient providers.
  • Periodically reviews provider profiling models to ensure projected cost savings are realized and recommends modifications as applicable.
  • Recommends standardized practices to optimize quality and cost of care.
  • Educates business stakeholders on provider profiling tools and insights.
  • May recommend alternative contract language.
  • Participates on project team involved with enterprise-wide initiatives.
  • Acts as a source of direction training and guidance for less experienced staff.

Job Qualifications: External

  • Requires a BS/BA degree and a minimum of 5 years’ experience in broad-based analytical, managed care, or provider environment; or any combination of education and experience which would provide an equivalent background.
  • Familiarity with SQL required.
  • Master’s degree preferred.

Preferred Skills:

  • Familiarity with provider cost and quality data strongly preferred.
  • Advanced level Excel and database skills strongly preferred.
  • Excellent analytical, organizational, planning, and ability to communicate effectively with multiple levels within the organization strongly preferred.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.

We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. 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 ability@icareerhelp.com for assistance.

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