Provider Contract/Cost of Care Consultant (US) at Elevance Health

Indianapolis, Indiana, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

BS/BA degree in Mathematics, Statistics, or related field
Minimum of 5 years’ experience in broad-based analytical work (inferred from context)
Ability to report to one of the Pulse Point locations (Indianapolis, IN; Norfolk, VA; Atlanta, GA; Nashville, TN; St. Louis, MO; or Louisville, KY) or within reasonable commuting distance from an office (hybrid: in-office 1 day per week)

Responsibilities

Provides analytical support to Provider Contracting, Product and Solutions organizations to lower claims costs, improve quality of care, and increase member/provider 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
Works with multiple post-acute care provider types (e.g., home health, skilled nursing facility) and supports a full range of contract arrangements and pricing mechanisms
Works on complex enterprise-wide initiatives and acts as project lead
Uses analytic tools to track health risks, compliance, and support contract negotiation
Builds and maintains Tableau dashboards from multiple data sources for network performance views across departments
Creates logic for reporting from databases such as SQL and other data warehouse sites
Performs sophisticated retrospective data analytics; builds/modifies complex models for predictive decision-making tools
Performs healthcare cost analysis to identify cost control strategies; projects cost increases via PMPM trending and multi-variable analysis
Prepares pre-negotiation analysis for defensible pricing strategies; models contract scenarios based on utilization patterns and 'what if' logic
Measures/evaluates cost impact of negotiations; researches provider financial profitability/stability and competitive environment
Projects cost savings targets based on analytics; identifies savings opportunities via referral patterns in post-acute, referral, and specialty care
Recommends policy changes and claims system changes for cost savings
Reviews post-implementation results to ensure savings are realized and recommends modifications
Recommends standardized practices to optimize cost of care
Educates provider contractors on contracting analytics from a financial impact perspective
Recommends alternative contract language and participates in virtual meetings with providers during negotiations
Participates on project teams for enterprise-wide initiatives; acts as source of direction, training, and guidance for less experienced staff

Skills

Provider Contracting

Cost of Care Analysis

Contract Negotiation

Health Risk Analytics

Compliance Tracking

Analytic Tools

Post-Acute Care

Skilled Nursing Facilities

Home Health

Project Management

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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