Location: this position will work a hybrid model (remote and office) which requires working in the nearest Elevance Health office 1-2 times per week. The rest of the time would be working remotely (from home). The ideal candidate will live within 50 miles of one of our Elevance Health office locations. **Open to any Elevance Health office**
The Provider Contract Cost-of-Care Consultant Sr. will provide the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations.
How you will make an impact:
- 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.
- Leads 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.
- Works with multiple provider types including the most complex, high profile providers.
- Supports a full range of contract arrangements and pricing mechanisms including the most complex contract terms.
- Works on the most complex, large scale enterprise wide initiatives and acts as project lead.
- Acts as a strategic partner to management.
- 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; developing the most complex new models and modifies existing 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 complex pre-negotiation analyses to support development of defensible pricing strategies; performing modeling to compare various contract scenarios based on member utilization patterns and 'what if'; 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 and 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.
- Researches provider's financial profitability/stability and competitive environment to determine impact of proposed rates.
- Communicates fee strategies to manage provider expectations.
- Provides on-going analytic and consultative support during complex and the most intense provider negotiations.
- Educates provider contractors on contracting analytics from a financial impact perspective.
- May recommend alternative contract language.
- May go on-site to provider premises during contract negotiations.
- Acts as a source of direction, training and guidance for less experienced staff.
- Looks for continuous quality improvements and finds better ways to accomplish end results.
- Works side by side with their manager.
Requires BA/BS degree in Mathematics, Statistics or related field and a minimum of 7 years experience in broad-based analytical, managed care payor or provider environment as well as in depth experience in statistical analysis and modeling; or any combination of education and experience which would provide an equivalent background.
Preferred skills, capabilities, and experiences:
- Experience providing leadership in evaluating and analyzing complex initiatives strongly preferred.
- Master's degree preferred.
- CMS reimbursement methodologies i.e. RBRVS, DRGs, APCs.
- Medicaid Managed Care financials or experience with State Medicaid programs funding and financials.
- Value Based Contracting analytics with Shared Savings or Risk Contract.
- Provider Capitation analytics.
- Ability to work within matrix environment with various customers and multi-faceted projects.
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $99,000 to $137,280.
Locations: California; Colorado; Nevada; New York; Washington State; Jersey City, NJ
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. 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.
Elevance Health operates in a Hybrid Workforce Strategy, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and 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 – 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.