Network Cost of Care Consultant

United States

Job Description

This position focuses on the development and tracking of cost of care reduction initiatives and requires significant financial analytical experience and demonstrated health care industry knowledge. Primary responsibilities include analyzing costs, preparing financial reports and providing recommendations to leadership for lines of business according to established policies, guidelines and methodologies. In addition, this position will work in conjunction with the Director and SVP of Network Strategy & Provider Solutions to conceive and execute on value based payment initiatives across Magellan Healthcare.

• Identifies key cost of care savings opportunities at the Network level, tracks and aligns suggestions with financial goals and reports expected outcomes to leadership.  
• Assists in the development of reimbursement frameworks and financial models and obtain necessary internal sign-offs (financial, network, operational etc.) to permit execution on those models. 
• Leads or coordinates cross-functional project/program teams with Business Owners of spend, category and vendor relationships, and trend bender development and implementation 
• Analyzes complex financial information and reports related to provider reimbursement methodologies, such as DRGs, APCs, bundled payments and RBRVS; provides accurate and timely financial recommendations to management for decision making purposes. 
• Develops sophisticated financial models. Provides recommendations based upon evaluation of financial trends and forecasts. 
• Evaluates and monitors the efficiency and performance of programs, ensuring program execution is on target. 
• Manages dashboard reporting by tracking monthly, quarterly and annual revenue and expenses. 
• Reviews historical operating results and proactively identifies and analyzes potential revenue enhancement and cost saving opportunities. 
• Performs a variety of pro forma financial and operating analyses as requested to support proposals. 
• Reviews and understands fluctuations across SBUs in delivering cost of care and variations in cost of care. Differentiates impact of rate versus utilization variations. 
• Supports SBUs by providing information, responding to questions and resolving complex problems and issues. 

General Job Information


Network Cost of Care Consultant



Job Family

Operations Group


United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date


Date Requisition Created


Minimum Qualifications


A Combination of Education and Work Experience May Be Considered. (Required), Bachelors (Required), Masters (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements


• Strong analytic and presentations skills. 
• Expresses ideas, recommendations and solutions clearly, logically and concisely. 
• Prioritizes tasks effective and has ability to work under tight deadlines in a highly dynamic environment. 
• Ability to develop and communicate analytic results to support business questions. 
• Demonstrated ability to well with a broad range of internal customers. 
• Proficiency in all Microsoft Office products, including Word, Excel, Access, and PowerPoint. 

• Ability to understand and analyze complex data sets and frame it to actionable analysis. 
• Understanding of the financial structure and business practices of the managed care industry. 
• Strong PC skills are essential, with advanced skills in Excel and Hyperion Essbase or other large enterprise financial software. 

Bachelors Degree

Masters Degree or Bachelor Degree with equivalent experience.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled