AnaheimRecruiter Since 2001
the smart solution for Anaheim jobs

Prov Contract/CofC Consult Sr.

Company: Anthem, Inc
Location: Anaheim
Posted on: March 25, 2020

Job Description:

Prov Contract/CofC Consult Sr. - PS32816Location: United StatesRequisition #: PS32816Post Date: Mar 13, 2020Your Talent. Our Vision. At Anthem, Inc., its a powerful combination, and the foundation upon which were creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care .This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.

  • Provides the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations.
  • 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.Primary duties may include, but are not limited to:
    • 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;
      • Developing the most complex new models and modifies existing models to create predictive impact decision making tools;
      • 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 complex pre-negotiation analyses to support development of defensible pricing strategies;
      • Performing modeling to compare various contract scenarios based on member utilization patterns and 'what if'; measuring and evaluating the cost impact of various negotiation;
      • Researching the financial profitability/stability and competitive environment of providers to determine impact of proposed rates;
      • Projects different cost of savings targets based upon various analytics.(Primary duties continued...)
        • Identifies cost of care savings opportunities by analyzing practice patterns in relation to office visits, referral practices, and specialty care procedures and recommends policy changes and claim's system changes to pursue cost savings.
        • Reviews results post-implementation to ensure projected cost savings are realized and recommends modifications as applicable.
        • Recommends 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.
        • Researches providers 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.Requires BA/BS degree in Mathematics, Statistics or related field; 7+ years experience in broad-based analytical, managed care payor or provider environment; in depth experience in statistical analysis and modeling; or any combination of education and experience, which would provide an equivalent background. Experience providing leadership in evaluating and analyzing complex initiatives required. Master's degree preferred.Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.

Keywords: Anthem, Inc, Anaheim , Prov Contract/CofC Consult Sr., Other , Anaheim, California

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


CDL A Truck Driver Needed! No Experience Required
Description: We set you up for success CRST supports and values our drivers and their accomplishments. Our hands-on approach provides 28 days of individual on-the-road training from a seasoned driver. We also offer (more...)
Company: CRST Expedited
Location: San Gabriel
Posted on: 04/8/2020

Mac Tools Seeking Mechanics - Technicians - Training Provided
Description: Build a Great Career and a Quality Life with Mac Tools. Feel the freedom and independence of working on your own, in a stress free environment - with no one to answer to, except yourself Join the family (more...)
Company: Mac Tools
Location: Santee
Posted on: 04/8/2020

CDL A Tank Driver
Description: Experience a better way to drive a tanker. About Messer Earn a great living and be part of a company in a way most carriers
Company: Messer North America INC.
Location: Rancho Palos Verdes
Posted on: 04/8/2020


Deliver Eats with Uber Eats
Description: Deliver with Uber. Earn on your schedule.Deliver with Uber Eats on your schedule. Deliver for a few hours in the mornings, every night, or just on weekends it's up to you.Earn Extra Money. You ll earn (more...)
Company: Uber Eats
Location: Santee
Posted on: 04/8/2020

CDL A Tank Driver
Description: Experience a better way to drive a tanker. About Messer Earn a great living and be part of a company in a way most carriers
Company: Messer North America INC.
Location: La Puente
Posted on: 04/8/2020

Real Estate Listing Specialist
Description: Job Description Real Estate is a fast-paced and exciting industry that is always moving and changing. We are searching for creative, dynamic and bright Real Estate Specialists to join our company. Buying (more...)
Company: Berkshire Hathaway HomeServices California Propert
Location: Hacienda Heights
Posted on: 04/8/2020

CDL A Tank Driver
Description: Experience a better way to drive a tanker. About Messer Earn a great living and be part of a company in a way most carriers
Company: Messer North America INC.
Location: Paramount
Posted on: 04/8/2020

CDL A Truck Driver Needed! No Experience Required
Description: We set you up for success CRST supports and values our drivers and their accomplishments. Our hands-on approach provides 28 days of individual on-the-road training from a seasoned driver. We also offer (more...)
Company: CRST Expedited
Location: La Quinta
Posted on: 04/8/2020

Deliver with Uber Eats this spring
Description: Deliver with Uber. Earn on your schedule.Deliver with Uber Eats on your schedule. Deliver for a few hours in the mornings, every night, or just on weekends it's up to you.Earn Extra Money. You ll earn (more...)
Company: Uber Eats
Location: Poway
Posted on: 04/8/2020

CDL A Tank Driver
Description: Experience a better way to drive a tanker. About Messer Earn a great living and be part of a company in a way most carriers
Company: Messer North America INC.
Location: Rosemead
Posted on: 04/8/2020

Log In or Create An Account

Get the latest California jobs by following @recnetCA on Twitter!

Anaheim RSS job feeds