Anticipated End Date:2026-09-05
Position Title:Cost of Care Manager
Job Description:Cost of Care ManagerLocation: This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
The
Cost of Care Manager 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.
How you will make an impact:- Partners with cross-functional teams to support cost of care initiatives across markets, states, business segments, and enterprise functions.
- Reviews post-implementation claims, utilization, provider reimbursement, payment policy, operational, and financial data to evaluate cost of care project performance.
- Works with Cost of Care Analytics, Finance, Actuarial, Claims, Provider Network, Care Management, IT, and business partners to analyze project outcomes, assess financial impact, and support performance discussions.
- Supports the development of financial models, savings validation, risk assessments, business cases, and performance tracking for cost of care initiatives.
- Reviews claims data after implementation to analyze trends related to unit cost, utilization, provider billing patterns, reimbursement changes, benefit configuration, claims operations, and potential payment leakage.
- Collaborates with actuarial and finance partners to compare projected savings against actual results and support accurate performance measurement and reporting.
- Helps develop and maintain dashboards, reports, executive summaries, and project tracking materials to communicate post-implementation performance and financial outcomes.
- Supports claims-related affordability initiatives, including payment integrity, claims editing, reimbursement policy review, vendor performance, benefit configuration, and operational process improvement.
- Provides data-driven recommendations and insights to business partners and leadership based on project performance, claims results, and financial outcomes.
- Participates in cost of care planning meetings, workgroups, and performance discussions to help monitor progress, risks, dependencies, actual savings, and financial impact.
- Serves as a claims and financial analysis resource for assigned cost of care initiatives and cross-functional business partners.
Minimum Qualifications:- 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.
Preferred Skills, Capabilities and Experiences:- Strongly preferred 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:Non-Management Exempt
Workshift:Job Family:PND > Network Contracting
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
