Value-Based Contract / Cost of Care Consultant SeniorThe Value-Based Contract / Cost of Care Consultant Senior will focus on Elevance Health's Value Base Contracts and will be responsible for providing the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations. As the core functions of the role, this position will support pre-negotiation modeling, reconciliation questions and other program support for primary care based value programs; partner with Payment Innovation to develop and enhance programs including but not limited to financial modeling of programmatic changes. Will support a full range of contract arrangements and pricing mechanisms including the most complex contract terms.Location: This position will work in a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of the Elevance Health PulsePoint locations on this posting.How you will make an impact:
Prepares healthcare cost analysis to identify new, innovative strategies to control cost.
Uses analytic tools to track health risks and compliance, as well as support the contract negotiation process.
Performs complex modeling and analytics exercises.
Performing healthcare cost analysis to identify strategies to control costs.
Projecting cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis.
Prepares negotiation prep analysis to support development of negotiation strategy.
Provides analytic support during complex provider negotiations.
Analyzes claims experience to identify cost of care initiative opportunities.
Researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates and projects different cost of savings targets based upon various analytics.
Evaluates cost impact of negotiation proposals.
Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable.
Communicates analysis and findings both internally and externally.
Provides day to day negotiation support for value-based programs.
Communicates fee strategies to manage provider expectations.
Minimum Requirements:
Requires BA/BS degree in Mathematics, Statistics or related field and a minimum of 7 years experience in broad-based analytical, managed care payor or provider environment as well as in depth experience in statistical analysis and modeling; or any combination of education and experience which would provide an equivalent background.
Preferred Skills, Capabilities, & Experiences:
Experience with Medicare & Commercial Lines of Business.
Experience with relational databases and knowledge of query tools.
Experience with Value Based Care.
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.
Experience providing leadership in evaluating and analyzing complex initiatives strongly preferred.
Master's degree preferred.
