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Provider Contract/Cost of Care Consultant

  • Job Family: Analytics
  • Type: Full time
  • Date Posted:
  • Req #: JR42116

Location:

  • Virginia, Virginia
  • Iowa, Iowa
  • Texas, Texas
  • Louisiana, Louisiana
  • Colorado, Colorado
  • Vermont, Vermont
  • Minnesota, Minnesota
  • Tennessee, Tennessee
  • Utah, Utah
  • Washington, Washington
  • South Dakota, South Dakota
  • Georgia, Georgia
  • South Carolina, South Carolina
  • Michigan, Michigan
  • Ohio, Ohio
  • Rhode Island, Rhode Island
  • Kentucky, Kentucky
  • North Dakota, North Dakota
  • Arkansas, Arkansas
  • New Jersey, New Jersey
  • Florida, Florida
  • District of Columbia, Washington
  • New Hampshire, New Hampshire
  • New York, New York
  • Kansas, Kansas
  • Delaware, Delaware
  • New Mexico, New Mexico
  • Indiana, Indiana
  • 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
  • West Virginia, West Virginia
  • Mississippi, Mississippi
  • Maine, Maine
  • Oklahoma, Oklahoma

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Description

Location:  Remote opportunity

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, Business partners and Management on cost of care issues. Works on 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. Can work with multiple provider types, e.g. physician, ancillary, medical groups, or hospitals. Supports a full range of contract arrangements and pricing mechanisms. Works on complex enterprise-wide initiatives and acts as project lead.

How you will make an Impact;

  • Uses analytic tools to track both health risks and compliance, as well as supporting the contract negotiation process.
  • Performs various types of analyses tied to cost and performance.
  • Identifies cost of care savings opportunities by analyzing practice patterns in relation to office visits, referral practices, and specialty care procedures.
  • 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.
  • May recommend alternative contract language and will interact with providers during contract negotiations.
  • Participates on project team involved with enterprise wide initiatives.
  • Creates and maintains databases to track business performance.
  • Develops and analyzes business performance reports (e.g. for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies.
  • May require taking business issue and devising best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.
  • May make recommendations based upon data analysis.
  • Provides analytic consultation to other business areas, leadership or external customers.
  • Data analysis and reporting encompasses a much higher level of complexity.

Minimum Requirements:

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 relational databases and knowledge of query tools and statistical software is strongly preferred (including SQL, SAS)
  • Background in Healthcare Analytics environment strongly preferred
  • Proficiency with MS Excel
  • Ability to manipulate large sets of data strongly preferred.
  • Healthcare Medical Provider Economics and/or Value Based Contracting working knowledge strongly preferred
  • Strong analytical, organizational, presentation, and problem solving skills strongly preferred

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $80,960 to $145,728.

Locations:  California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company.  The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.


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.ElevanceHealth.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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