at Elevance Health in CHICAGO, Illinois, United States
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Provider Contract / Cost of Care Consultant
+ Job Family: Analytics
+ Type: Full time
+ Date Posted:Nov 28, 2023
+ Reference: JR89302
+ CA, COSTA MESA
+ CA, WOODLAND HILLS
+ NJ, MORRISTOWN
+ WI, Waukesha
+ FL, MIAMI
+ IN, INDIANAPOLIS
+ OH, MASON
+ OH, CINCINNATI
+ CA, WALNUT CREEK
+ KY, LOUISVILLE
+ NY, NEW YORK
+ WA, SEATTLE
+ NH, MANCHESTER
+ TX, GRAND PRAIRIE
+ IL, CHICAGO
+ TN, NASHVILLE
+ NY, MIDDLETOWN
+ LA, METAIRIE
+ MN, GILBERT
+ DC, WASHINGTON
+ GA, MIDLAND
+ NV, LAS VEGAS
+ MN, MENDOTA HEIGHTS
+ TX, HOUSTON
+ VA, NORFOLK
+ MO, ST LOUIS
+ CT, WALLINGFORD
+ NC, CARY
+ MD, HANOVER
+ NJ, ISELIN
+ WV, CHARLESTON
+ DE, WILMINGTON
+ OH, MASON
+ OH, SEVEN HILLS
+ RI, SMITHFIELD
+ CO, DENVER
+ NV, LAS VEGAS
+ CA, PALO ALTO
+ NC, WINSTON
+ ME, SOUTH PORTLAND
+ GA, ATLANTA
+ NY, LATHAM
+ OH, COLUMBUS
+ VA, RICHMOND
+ FL, TAMPA
+ IA, W DES MOINES
+ VA, ROANOKE
+ MA, WOBURN
Provider Contract / Cost of Care Consultant
Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our office locations.
The Provider Contract / Cost of Care Consultant is responsible for providing analytical support to the Cost of Care and/or Provider Contracting organizations for the Western region. This position is within our Value Based Advisory team within HealthCare Economics focusing 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.
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;
+ Projecting 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 Experiences:
+ Proficiency with Teradata, SAS, SQL and Excel
+ Experience with Tableau
+ Experience with Value-based programs
+ Health Economics background
+ Healthcare background
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $81,520 to $146,736.
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 for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success – for our consumers, our associates, our communities and our business.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and ince