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Staff VP Provider Economics-124892 in Culver City, CA at Anthem, Inc.

Date Posted: 8/2/2018

Job Snapshot

Job Description

Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company

•Thousand Oaks or Woodland Hills offices preferred.
Leader accountable for all medical provider network analytics in the California market.   Primary duties may include, but are not limited to:
  • Provides consultation and analytic support on network strategies, negotiation strategy and cost of care issues and opportunities. 
  • Financial impact analysis in support of negotiations with integrated delivery systems, hospitals, professional providers (both capitated and fee-for-service) and ancillary providers. 
  • Develops and maintains provider unit price forecasts.
  • Tracks key provider negotiations for senior management reporting. 
  • Oversees the analytics and reporting that support the capitated medical group environment in the CA market, including support for medical cost performance / MLR drilldown, incentive programs, narrow network development / maintenance, profitability analysis and cap leakage. 
  • Drives analytical solutions that best leverage scalable, enterprise solutions to support provider enablement and population health management.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Requires a BA/BS degree in Business; 7+ years’ experience in broad-based analytical, managed care environment; management experience; or any combination of education and experience, which would provide an equivalent background. 5+ years of experience with the analysis and/or capability development in support of capitated delivery systems strongly preferred.  Experience with industry-standard normalization methodologies, examples including DRG groupers/weights, APC, RVU, ETG, PEG and DxCG risk score or other population risk-adjustment platform.  MBA preferred.  Exceptional problem solving, analytical, oral and written communication, and leadership skills.