Provider Contract​/Cost of Care Consultant

Anticipated End Date:

Position Title: Provider Contract/Cost of Care Consultant

Job Description:

This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Ideal candidates will be able to report to one of our Pulse Point locations in Indianapolis, IN, Atlanta, GA, Mason, OH, Richmond, VA or Norfolk, VA.

Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, 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.

• Uses analytic tools to track both health risks and compliance, as well as supporting the contract negotiation process.
• Performs sophisticated retrospective data analytics.
• Builds new and modifies existing complex models to create predictive impact decision making tools.
• Performs healthcare cost analysis to identify strategies to control costs.
• Projects cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis.
• Performs modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic.
• Researches the financial profitability/stability and competitive environment of providers to determine impact of proposed rates.
• 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.
• 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.
• Recommends 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 of 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.

• Duals experience highly preferred.
• Proficiency in data manipulation tools such as SQL, SAS, or similar highly preferred.
• Exceptional analytical, organizational, presentation, and problem-solving skills preferred.
• Cost of care analysis knowledge preferred.

Job Level: Non-Management Exempt

Workshift: 1st Shift (United States of America)

Job Family: RDA >
Health Economics >
Cost of Care

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 elevancehealthj for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.