Provider Contract Cost of Care Consult Senior / VBC

Elevance Health•New York, NY

19d•Hybrid

About The Position

Provider Contract Cost of Care Consult Senior / VBC Location: This role requires associates to be in-office 1-2 days 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. 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. The Provider Contract Cost of Care Consult Senior / VBC is responsible for providing the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations. How you will make an impact: 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. Leads 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. Works with multiple provider types including the most complex, high-profile providers. Supports a full range of contract arrangements and pricing mechanisms including the most complex contract terms. Works on the most complex, large-scale enterprise-wide initiatives and acts as project lead. Acts as a strategic partner to management. 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 Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable. Recommend 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. Research provider's financial profitability/stability and competitive environment to determine impact of proposed rates. Communicates fee strategies to manage provider expectations. Provides on-going analytic and consultative support during complex and the most intense provider negotiations. Educates provider contractors on contracting analytics from a financial impact perspective. May recommend alternative contract language. May go on-site to provider premises during contract negotiations. Acts as a source of direction, training and guidance for less experienced staff. Looks for continuous quality improvements and finds better ways to accomplish end results. Works side by side with their manager.

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.

Nice To Haves

Experience providing leadership in evaluating and analyzing complex initiatives strongly preferred.
Master's degree preferred.

Responsibilities

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.
Leads 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.
Works with multiple provider types including the most complex, high-profile providers.
Supports a full range of contract arrangements and pricing mechanisms including the most complex contract terms.
Works on the most complex, large-scale enterprise-wide initiatives and acts as project lead.
Acts as a strategic partner to management.
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 Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable.
Recommend 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.
Research provider's financial profitability/stability and competitive environment to determine impact of proposed rates.
Communicates fee strategies to manage provider expectations.
Provides on-going analytic and consultative support during complex and the most intense provider negotiations.
Educates provider contractors on contracting analytics from a financial impact perspective.
May recommend alternative contract language.
May go on-site to provider premises during contract negotiations.
Acts as a source of direction, training and guidance for less experienced staff.
Looks for continuous quality improvements and finds better ways to accomplish end results.
Works side by side with their manager.