Leads and manages multiple cost of care initiatives enterprise wide (e.g. local, within each state, across business segments and at the enterprise level) and drives their execution.
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 competitiveness.
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.
Oversee the identification of potential cost of care savings opportunities through complex analytics via partnering with the cost of care analytics team, to develop 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 State Plan Presidents.
Serves on local and enterprise committees.
Plans, leads and oversees cost of care planning meetings and tracks and reports on cost of care projects.

Requirements

Requires a BS/BA degree and minimum of 5 years relevant experience in Health Care; or any combination of education and experience, which would provide an equivalent background.
Prior experience with provider network contracting, provider networks, claims, finance, and operations
SQL experience strongly preferred
Experience in broad-based analytical, managed care payor or provider environment as well as experience in statistical analysis and healthcare modeling preferred
MBA, MHA, MA preferred
PMP or Six Sigma Green Belt preferred

Benefits

comprehensive benefits package
incentive and recognition programs
equity stock purchase
401k contribution
merit increases
paid holidays
Paid Time Off
medical benefits
dental benefits
vision benefits
short and long term disability benefits
wellness programs
financial education resources

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

SQLstatistical analysishealthcare modelingcost of care analyticsprovider network contractingutilization managementfinancial operationscost savings quantificationdata analysisproject management

Soft Skills

leadershipnegotiationcommunicationcollaborationstrategic planningproblem-solvingpresentation skillsinitiativeteam managementorganizational skills

Certifications

PMPSix Sigma Green BeltMBAMHAMA