Provider Collaboration Director-Cost of Care

Provider Collaboration Director – Cost of Care

Location: This position will work a hybrid model (remote and office). Must reside within 50 miles/1 hour commute of our Miami or Tampa, FL Elevance Health location.

The Provider Collaboration Director-Cost of Care is responsible for local management of all network cost of care initiatives inclusive of Medicaid, Medicare, and Commercial lines of business.

How you will make an impact:

Identifies and develops best practices and cost of care improvement processes around physician, hospital, ancillary, and subcontractor network contract negotiation strategies, utilization management efforts, new products, annual benefit design participation, and financial operations.

Develops, manages, oversees, and executes new and innovative initiatives to manage rising costs and enhance the companys market competitiveness

Oversees the identification of potential cost of care savings opportunities through complex analytics via partnering with the cost of care analytics team, to developing action plans, benefits and risk assessments and overseeing and partnering with the actuarial team to develop and ensure accurate savings quantification.

Champions cost of care initiatives, drives medical and behavioral health integration initiatives.

Collect and consolidate monthly requests from teams, collaborating with finance, legal, and compliance teams to gather input, and present proposals to the governing body for review and decision-making at monthly meetings.

Manages and presents cost of care projects to senior leadership including State Plan Presidents.

Minimum Qualifications:

Requires knowledge of regulatory requirements for line of business.

Requires a BA/BS degree and a minimum of 8 years’ experience in contracting (value based, shared savings and Accountable Care Organization (ACO) development), provider relations, provider servicing; experience must include prior contracting experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

Prior experience with provider network contracting, provider networks, claims, finance, and operations.

Experience with Medicaid, Medicare, and Commercial lines of business preferred

MBA, MHA, or MA preferred

PMP or Six Sigma Green Belt preferred

Strong analytical, organizational, and problem-solving skills are strongly preferred

MS Office Suite of Tools desired, advanced Excel experience 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.