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. 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.
- 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.
- 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 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, 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 may go on-site to provider premises during contract negotiations.
- Participates on project team involved with enterprise wide initiatives.
- Acts as a source of direction, training and guidance for less experienced staff.
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 Experience:
- Master's degree preferred.
- SAS & SQL skills 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. A Fortune 20 company with a longstanding history in the healthcare industry, 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 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 – 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 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. 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 firstname.lastname@example.org for assistance.