Leads and manages multiple cost of care initiatives including the most complex initiatives enterprise wide (e.g. local, within each state (specifically Maine and New Hampshire), across business segments and at the enterprise level) and drives their execution. Understands, predicts and implements measures to control healthcare costs and to make healthcare more affordable for our customers. Develops, manages, oversees, and executes new and innovative initiatives to manage rising costs and enhance the company's market competiveness.
Primary duties may include, but are not limited to:
- Identifies and develops best practices and cost of care improvement processes around physician, hospital and ancillary network contract negotiation strategies, utilization management efforts, new products, annual benefit design participation, and financial operations.
- Oversees the identification of potential cost of care savings opportunities through complex analytics via partnering with the cost of care analytics team, to developing action plans, benefits and risk assessments and overseeing and partnering with the actuarial team to develop and ensure accurate savings quantification.
- Champions cost of care initiatives, negotiates for human capital resources, and partners with care management, claims, IT, and business partners.
- Manages and presents cost of care projects to local leadership, specifically for the states of Maine and New Hampshire.
- Serves on local and enterprise committees.
- Plans, leads and oversees cost of care planning meetings and tracks and reports on cost of care projects.
- May mentor and/or provide training and assistance to Cost of Care Mgrs.
Requires a BS/BA degree; and minimum of 9 years relevant experience in Health Care; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experience:
- Strongly preferred Financial, Business, and Leadership acumen; MBA, MHA, MA; PMP or Six Sigma Green Belt;
- Prior experience with provider network contracting, provider networks, claims, finance, and operations.
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 firstname.lastname@example.org for assistance.