Consultant

• 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.
• Uses analytic tools to track both health risks and compliance, as well as supporting the contract negotiation process.
• Performs sophisticated retrospective data analytics.
• Develops the most complex new models and modifies existing models to create predictive impact decision making tools.
• Performs healthcare cost analysis to identify strategies to control costs.
• Projects cost increases in medical services by using analytic techniques for PMPM trending via multiple variable analysis.
• Prepares complex pre-negotiation analyses to support development of defensible pricing strategies.
• Performs modeling to compare various contract scenarios based on member utilization patterns and 'what if'.
• Researches 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.
• 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.
• Recommends alternative contract language and may go on-site to provider premises during contract negotiations.
• Communicates fee strategies to manage provider expectations.
• Provides on-going analytic and consultative support during complex and the most intense provider negotiations.
• Acts as a source of direction, training and guidance for less experienced staff.

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