Elevance Health Senior Healthcare Economics / Cost of Care Consultant in Ashburn, Virginia
Senior Healthcare Economics / Cost of Care Consultant
Job Family: Analytics
Type: Full time
Date Posted:Aug 02, 2022
Req #: PS70506
West Virginia, West Virginia
Job Title: Senior Provider Contract / Cost of Care Consultant
Provides the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations focusing efforts on analyzing medical cost trends, lowering claims costs, improving the quality of care, and increasing member and provider network satisfaction.
Primary duties may include, but are not limited to:
Provides expert advice, analytic and consultative support to Medical Directors and management on cost of care issues.
Leads complex, large-scale enterprise-wide initiatives with high-dollar cost-savings opportunities.
Analyzes a full range of contract arrangements and pricing mechanisms including the most complex contract terms.
Performs healthcare cost and trend analysis to identify strategies to control costs.
Types of analyses include performing sophisticated retrospective data analytics; developing the most complex financial models and modifying existing models to create Cost of Care decision making tools.
Validates Health Plan cost savings initiatives, ensuring consistent and established analytical methods and standards. Provides ongoing support, including sizing and validation, of Cost of Care initiatives, to Business Unit leaders.
Projects cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis.
Ensures that all Cost of Care initiatives include validated measurement methodologies using consistent and established analytical methods and standards. Reviews and monitors results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable.
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.
Recommends standardized practices to optimize cost of care.
Educates provider contractors on contracting analytics from a financial impact perspective. Presents models during workgroup calls and explains analyses to a diverse audience.
Acts as a source of direction, training and guidance for less experienced staff.
Looks for continuous quality improvements and finds better ways to accomplish results.
Works side by side with their manager.
Requires BA/BS degree in Mathematics, Statistics or related field
Minimum of 7 years’ experience in broad-based analytical, managed care pay or provider environment as well as experience in statistical analysis and modeling;
Or any combination of education and experience which would provide an equivalent background.
SQL or SAS experience required
Advanced Excel skills required
Experience with healthcare data required (Medicare data preferred)
Experience manipulating large data sets
Experience providing leadership in evaluating and analyzing complex initiatives strongly preferred
Value-Based Contracts/Care experience preferred
Healthcare economics knowledge preferred
Masters degree preferred
Preferred Key Competencies
Leadership and presentation skills. Willingness to stand ground but be open to feedback. Responsive and proactive.
Communication: Explain complex financial considerations to non-technical audiences.
Implementation/Execution: Good at organizing and managing multiple priorities and/or projects, with ability to pivot quickly and juggle tasks.
Flexible: Ability to provide initial feedback/reactions on the fly, and to interpret between financial considerations and clinical decisions/actions.
Problem Solving: Solve problems with the ability to encourage others in collaborative problem solving.
Knowledge of Cost of Care levers and methodologies: What options do customers have to address cost of care issues? What needs to be considered for prospective projection and retrospective evaluation?
Willing and quick learner.
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. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
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 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 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.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 email@example.com for assistance.
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