Anticipated End Date:

2025-03-21

Position Title:

Provider Economics Director

Job Description:

Provider Economics Director

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

The Provider Economics Director plans, directs, and controls the resources and efforts of the reporting and analytics team to accomplish the company objectives through information management. This position is responsible for methodology development, financial model design, and forecasting the impact of provider payment models for all lines of business. It will value new medical cost initiatives, applying financial modeling expertise and using independent judgment to determine the best methods and approaches to calculate accurate estimates of program savings.

How you will make an impact:

•    Develop and implement advanced statistical models to assess healthcare costs, utilization, and performance metrics.
•    Provide analytical support for strategic initiatives, such as contract negotiations, provider network optimization, and total cost of care management.
•    Thoroughly vet and perform due diligence on potential value-based arrangements to assess financial impact, ensure operational feasibility, and identify impact on existing programs.
•    Conduct comprehensive analysis of healthcare data, claims, and financial reports to identify trends, patterns, and opportunities for improvement.
•    Obtains resources (people, funding, material, support) to support business unit information needs and strategic initiatives. 
•    Provides leadership in motivating team members to accomplish reporting and analytics goals and objectives. 
•    Reports project status and progress to business unit senior management. Ensures accuracy and timeliness of output and deliverables for assigned functional areas. 
•    Implements the policies, practices, and procedures of the company and business units supported. 
•    Provide input on area budgets. 

•    Establishes relationships with business users both internal and external to the department. 
•    Oversees entire reporting/analysis/consulting unit or all aspects of a centralized function. 
•    Partners with senior leadership to establish strategic plans and objectives. 
•    Makes final decisions for IM function at the business unit level and ensures operations' effective achievement of objectives. 
•    Coordinates project management for assigned team.
•    Ability to communicate with customers about technical issues in non-technical terms. 
•    Understands the business processes that the system supports

Minimum Requirements:

Requires a BA/BS degree and a minimum of 10 years experience leading project teams, or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

•    Knowledge of IM technologies, organizational structure, and customer information needs strongly preferred. 
•    Prior leadership or management experience preferred. 
•    Effective communication skills, including facilitation, consultation, negotiation, and persuasion preferred.
•    Deep knowledge of value-based care and/or population health management is strongly preferred.
•    Progressive experience leading and performing analytical work within the healthcare industry (i.e., health plans, large physician practices, hospitals, ancillary, medical facilities, healthcare vendor, etc.) preferred.
•    Experienced with SAS, SQL, or similar data manipulation tools, where you have created efficient and transparent queries, pulled large data sets, and performed data manipulations/analysis.
•    Skilled at using data to tell financial stories with recommendations on how to create PMPM efficiencies and reduce cost
•    A Self-motivated, creative problem solver who can work independently and collaborate through strong communication and interpersonal skills is preferred.
•    Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG's), Ambulatory Patient Groups (APG's), Ambulatory Payment Classifications (APC's), and other payment mechanisms.
•    BA/BS degree in Actuarial Sciences, Health Economics, Statistics
•    Minimum of 10 years in the healthcare industry in med econ, provider finance, healthcare analytics, and actuarial services is preferred.

For candidates working in person or remotely in the below location, the salary* range for this specific position is $136,488 to $204,732

Location: Chicago, Illinois

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law
 

Job Level:

Director Equivalent

Workshift:

Job Family:

RDA > Reporting & Data Analysis

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 and Influenza. 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. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.