at Elevance Health in Westchester, Illinois, United States
Job Description
Provider Contract / Cost of Care Consultant Senior
+ Job Family: Analytics
+ Type: Full time
+ Date Posted:May 25, 2023
+ Req #: JR72087
Location:
+ New York, New York
+ Iowa, Iowa
+ Texas, Texas
+ Virginia, Virginia
+ 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
+ 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
Description
Location: Remote opportunity, EST and CST preferred
The Health Economist (Provider Contract/Cost of Care Consultant Senior) role provides the highest level of 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. 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.
How you will make an Impact;
+ Uses and develops 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.
+ Acts as a source of direction, training and guidance for less experienced staff.
Minimum Requirements:
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 with Value-base contracting/economics
+ Experience providing leadership in evaluating and analyzing complex initiatives strongly preferred
+ Master’s degree
+ Strong experience with Excel
+ Experience with Tableau, Power BI
+ Healthcare background
+ Experience with Teradata, SAS, and SQL
+ Provider experience preferred
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $99,840 to $179,712.
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. 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
