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jobs description

Provider Cost of Care Consultant

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

Preferred Location: Columbia, MO.

The Provider Cost of Care Consultant is responsible for providing analytical support to the Cost of Care and/or Provider Contracting organizations.

How you will make an impact:
• 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 contracting strategy and supports all aspects of the contract negotiation process.
• Can work with multiple... provider types, e.g. physician, 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.
• Uses analytic tools to track both health risks and compliance, as well as supporting the contract negotiation process.
• Types of analyses include performing sophisticated retrospective data analytics.
• Building new and modifying existing complex models to create predictive impact decision making tools.
• 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.
• Preparing pre-negotiation analysis to support development of defensible pricing strategies.
• Performing modeling to compare various contract scenarios based on member utilization patterns and 'what if' logic; measuring and evaluating the cost impact of various negotiation.
• Researching 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 claim's 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.
• May recommend 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.

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:
• Master's degree preferred.



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