Director II, Provider Economics
Elevance Health

Job Info

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Director II, Provider Economics

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

The Director II, Provider Economics will be responsible for providing analytical and strategic planning for managing financial modeling, forecasting for payment models and developing reimbursement methodologies for all lines of business to guide the long-term payment strategy for the enterprise.

How you will make an impact:

• Evaluates the effectiveness and performance of healthcare networks and related costs and benefits
• Collaborate with Carelon Health leaders on the development of alternative payment models that support specialty clinical domains, including VBC penetration, downside risk growth, and performance across financial, quality, and health equity domains.
• Uses modeling tools and reporting to identify and quantify contracting and outcomes-based financial impacts of existing and potential new business
• Oversees enterprise teams providing analytic and consultative strategy services related to the company's payment model design and program performance
• Evaluates new program design and analytic execution strategy of upcoming programs to continuously expand and innovate the multi-year analytic roadmap to ensure value-based care commitments are met
• Applies methodologies and modeling of provider payments, financial, and economic measures
• Hires, trains, coaches, counsels, and evaluates performance of direct reports

Minimum Requirements:

Requires a BA/BS degree in Business or related field and a minimum of 10 years of experience in broad-based analytical, managed care payor or provider environment as well as minimum of 5 years management experience in the healthcare industry or large multi-operational corporate environment; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

• Master's degree strongly preferred

• Experience with reimbursement strategy and designing alternative payment models including Capitation, Total Cost Shared Savings/Risk, and Episode Bundle Payments

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