Provider Contract/Cost of Care Consultant (US)
Company: Elevance Health
Location: Saint Paul
Posted on: May 28, 2023
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Job Description:
Provider Contract/Cost of Care Consultant (US)
Job Family: Analytics
Type: Full time
Date Posted:Apr 12, 2023
Req #: JR65236
Location:
IN, INDIANAPOLIS
CA, WOODLAND HILLS
GA, ATLANTA
OH, MASON
National +50 Miles away from nearest PulsePoint, National +50 Miles
away from nearest PulsePoint
Description
The Provider Contract/Cost of Care Consultant 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 initiative 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.
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.
Requirements:
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.
Assets and preferred qualifications:
Master's degree
Skilled in/with relational databases such as SQL, Teradata,
Snowflake and applications such as Microsoft PowerBi or Tableau
R or Python experience
For candidates working in person or remotely in the below
locations, the salary* range for this specific position is
$81,520.00 to $101,900.00
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 .
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
ability@icareerhelp.com for assistance.
EEO is the Law
Equal Opportunity Employer / Disability / Veteran
Please use the links below to review statements of protection from
discrimination under Federal law for job applicants and
employees.
EEO Policy Statement
Know Your Rights
Pay Transparency
Privacy Notice for California Residents
Elevance Health, Inc. is anE-verify Employer
(https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf)
Need Assistance?
Email us (elevancehealth@icareerhelp.com) or call
1-877-204-7664
Keywords: Elevance Health, St. Paul , Provider Contract/Cost of Care Consultant (US), Professions , Saint Paul, Minnesota
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