Provider Contract​/Cost of Care Consultant

Provider Contract/Cost of Care Consultant

Location:

This role requires associates to be in-office 1–2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work‑life balance. Alternate locations may be considered if candidates reside within a commuting distance from an office. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment unless an accommodation is granted as required by law.

• Provides 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.
• Works on large‑scale initiatives with high dollar cost savings opportunities.
• Partners with provider contractors to develop a contracting strategy and support all aspects of the contract negotiation process.
• Can work with multiple provider types, e.g., physicians, 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.
• Creates and maintains databases to track business performance.
• Analyzes data and summarizes performance using summary statistical procedures.
• Develops and analyzes business performance reports (e.g., for revenue, claims, provider, member, and utilization data) and provides notations of performance deviations and anomalies.
• Creates and publishes periodic reports, as well as any necessary ad‑hoc reports.
• Develops diagnostic and/or tracking data that translates business requirements into decision‑support tools.
• Programs and writes queries and reports.
• Conducts training on the use of applications developed.
• Works with internal and external customers to solve business problems.

• BS/BA degree in Mathematics, Statistics, or a related field.
• Minimum of 5 years experience in a broad‑based analytical, managed‑care payor or provider environment.
• Considerable experience in statistical analysis and healthcare modeling, or an equivalent combination of education and experience.

• Experience with Medicare & Commercial Lines of Business.
• Experience with relational databases and query tools.
• Ability to manipulate large sets of data.
• Strong analytical, organizational, and problem‑solving skills.
• Experience in SQL, SAS, Teradata, and relational databases.
• MS Office Suite of tools, with advanced Excel experience preferred.
• Tableau, Business Objects, or other reporting tools preferred.
• Good client‑facing skills.
• Exposure to Python and R preferred.

Non‑Management Exempt.

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 should submit the Accessibility Accommodation Request Form.