Cost of Care Director
Anthem Blue Cross & Blue Shield
Position Title:Cost of Care Director
Location: Must be within a 50-mile radius of an Elevance Health PulsePoint site.
Elevance Health supports a hybrid workplace model (virtual and in-office) with PulsePoint sites used for collaboration, community, and connection. This position will take part in the hybrid workforce strategy which includes virtual work and 1-2 days in office, per week.
The Cost of Care Director is responsible for leading and managing multiple behavioral health cost of care initiatives across assigned markets including the most complex initiatives enterprise wide (e.g. local, within each state, across business segments and at the enterprise level) and drives their execution.
How You Will Make an Impact:
Primary duties may include, but are not limited to:
- Understands, predicts and implements measures to control healthcare costs and to make healthcare more affordable for our customers.
- Develops, manages, oversees, and executes new and innovative initiatives to manage rising costs and enhance the company's market completeness.
- Ensures incrementally new initiatives are articulated, captured, and documented and managed through the SNOW process to deployment.
- Identifies and develops best practices and cost of care improvement processes around physician, hospital and ancillary network contract negotiation strategies, utilization management efforts, new products, annual benefit design participation, and financial operations.
- 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, negotiates for human capital resources, and partners with care management, claims, IT, and business partners.
- Manages and presents cost of care projects to senior leadership including Carelon leadership. Serves on local and enterprise committees.
- Plans, leads, and oversees cost of care planning meetings and tracks and reports on cost of care projects. May mentor and/or provide training and assistance to Cost of Care Mgrs.
Requires a BS/BA degree; and minimum of 9 years relevant experience in Health Care; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences:
- Strongly prefer financial, business, and leadership acumen
- MBA, MHA, MA; PMP or Six Sigma Green Belt
- Prior experience with provider network contracting, provider networks, claims, finance, and operations.
Job Level:Director Equivalent
Workshift:1st Shift (United States of America)
Job Family:PND > Network Contracting
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
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, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and 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 – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.