Provider Contract Cost of Care Consultant Senior

Provider Contract Cost of Care Consultant Senior Location: This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. The Provider Contract Cost of Care Consultant Senior provides 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. 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 claims 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. Research provider's financial profitability/stability and competitive environment to determine impact of proposed rates. Communicates fee strategies to manage provider expectations. Provides ongoing analytic and consultative support during complex and the most intense provider 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. 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 providing leadership in evaluating and analyzing complex initiatives strongly preferred. Master's degree preferred. Jira experience preferred. Tableau experience preferred. #J-18808-Ljbffr Elevance Health