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Value Based Contract / Cost of Care Consultant

The Value Based Contract / Cost of Care Consultant will focus on Elevance Health's Value Base Contracts and will be responsible for providing analytical support to the Cost of Care and/or Provider Contracting organizations. 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. 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..

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 both health risks and compliance, as well as supporting 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.

• Preparing pre-negotiation analysis to support the development of defensible pricing strategies.

• Provides analytic support during complex provider negotiations.

• Analyzes claims experience to identify cost of care initiative opportunities.

• Measuring and evaluating the cost impact of various negotiations.

• 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.

• Educates provider contractors on contracting analytics from a financial impact perspective.

• Communicates analysis and findings both internally and externally.

• Provides day-to-day negotiation support for value-based programs.

• 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, & 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.

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 elevancehealthjobssupport@elevancehealth.com for assistance.