Provider Contract/Cost of Care Consultant - Delaware, United States - Elevance Health

Description

Job Description

Provider Contract/Cost of Care Consultant

Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.

The Provider Contract/Cost of Care Consultant 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, and 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.

How you will make an impact:

• 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.

• May require taking business issues and devising the best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.

• May make recommendations based on data analysis.

• Programs and writes queries and reports.

• Conducts training on the use of applications developed.

• Work with internal and external customers to solve business problems.

Minimum Requirements:

Requires BS/BA degree in Mathematics, Statistics, or related field; minimum of 5 years 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.

Preferred Skills, Capabilities and Experiences:

• Must have experience with Medicare & Commercial Lines of Business.

• Experience with relational databases and knowledge of query tools.

• Ability to manipulate large sets of data.

• Strong analytical, organizational, and problem-solving skills are strongly preferred.

• Experience in SQL, SAS, Teradata, and relational databases is highly desired.

• MS Office Suite of tools desired, advanced Excel experience preferred.

• Tableau, Business Objects, or other reporting tools preferred.

• Strong analytical, organizational, and problem-solving skills are highly preferred.

• Good client-facing skills.

• Exposure to Python and R preferred.

Job Level:

Workshift:

Job Family:

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

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 for assistance.