Healthcare Cost Outcomes Strategy Director

Elevance Health•Indianapolis, IN

1d•Hybrid

About The Position

The Healthcare Cost Outcomes Strategy Director is responsible for managing the development and implementation of medical expense management initiatives for assigned Carelon Health business unit. This role oversees the development and execution of new and innovative initiatives specific to the Carelon Health, enterprise or one or more health plans, managing rising costs and enhancing the company's market competitiveness. The director understands all aspects of the business and partners with executive leadership to define strategy and successful criteria for the future. They identify and develop best practices and cost of care improvement processes around physician, hospital and ancillary network contract negotiation strategies, utilization management efforts, new products, annual benefit design participation, and operations. The role also involves overseeing the identification of potential cost of care savings opportunities through complex analytics, development of action plans, benefits and risk assessments, and partnering with the actuarial team to develop and ensure accurate savings quantification. The director champions cost of care initiatives, negotiates for human capital resources, and partners with care management, network, claims & operational teams, IT, and business partners. They build and leverage relationships to provide innovative solutions to complex business problems and propose opportunities to improve results based on continuous needs assessment. The position is responsible for the development, implementation, and monitoring of line of business planning and project activities.

Requirements

BA/BS degree in a related field
Minimum of 10 years of related experience including prior leadership experience
3 to 5 years strategic planning experience
Any combination of education and experience, which would provide an equivalent background

Nice To Haves

MBA, MHA and PMP or Six Sigma Green Belt
Financial, Business, and Leadership acumen
Prior experience with managed care, trend & healthcare analytics, provider networks, claims, finance, and operations
Healthcare payer experience
Cost of Care knowledge and experience
Executive presence and the ability to influence

Responsibilities

Oversees the development and execution of new and innovative initiatives specific to the Carelon Health, enterprise or one or more health plans, managing rising costs and enhancing the company's market competitiveness.
Understands all aspects of the business and partners with executive leadership to define strategy and successful criteria for the future.
Identifies and develops best practices and cost of care improvement processes around physician, hospital and ancillary network contract negotiation strategies, utilization management efforts, new products, annual benefit design participation, and operations.
Oversees the identification of potential cost of care savings opportunities through complex analytics, development of action plans, benefits and risk assessments and partners with the actuarial team to develop and ensure accurate savings quantification.
Champions cost of care initiatives, negotiates for human capital resources, and partners with care management, network, claims & operational teams, IT, and business partners.
Builds and leverages relationships to provide innovative solutions to complex business problems.
Proposes opportunities to improve results based on continuous needs assessment.
Responsible for the development implementation and monitoring of line of business planning and project activities.
Travels to worksite and other locations as necessary.