Director, Managed Care

This is a fully remote position, open to applicants in Illinois, +1 more state.

📋 Description

• Oversee the entire managed care contracting process, encompassing analytics, strategy formulation, negotiations, and post-contract execution.

• Create and implement managed care strategies, which include commercial rate benchmarking, payer price transparency analytics, and contract negotiations.

• Attract new clients to the firm, aiming for a partner-level revenue target of $8 million or more.

• Provide strategic insights to C-suite executives to enhance revenue and improve market positioning.

• Direct business development initiatives for advisory pursuits within the designated territory or market.

• Lead advisory and delivery teams on significant transformation projects.

• Develop a portfolio of business through senior client relationship management, identifying, securing, and executing managed care growth initiatives.

• Supervise consulting experts and advisory staff across key accounts.

• Propel contract growth and identify, initiate, and secure new opportunities for revenue cycle programs.

• Manage transactions ranging from $500K to multi-million-dollar annual contracts, including multi-year managed services.

• Support Next Gen Payer-Provider healthcare collaborative initiatives.

• Cross-sell Guidehouse services to enhance account and market presence.

• Innovate managed care deal structures, collaboration opportunities, and portfolio strategies.

• Cultivate and enhance relationships with CEOs, CFOs, CTOs, and other senior executives.

• Advise clients on operational best practices, industry trends, market advancements, and technological innovations.

• Collaborate across Guidehouse to maximize client value.

• Build and maintain internal and external business and industry relationships.

• Mentor consultants on developing executive relationships and managed care sales.

• Oversee sales and delivery, identify opportunities, and finalize entry-point projects to broaden revenue-cycle engagements.

⛳️ Requirements

• 10+ years of professional experience in healthcare management, strategy, consulting, or related fields.

• Previous executive consulting or industry leadership experience in Medicaid, Medicare/Medicare Advantage, accountable care organizations, or patient-centered medical homes is highly preferred.

• Experience in ACO leadership, managed care, health plan or payer leadership, executive-level contract management, IT/data management, quality management, client-facing healthcare consulting, or health policy analysis and health economics research.

• Familiarity with risk prediction and adjustment methodologies, performance-based procurement, and quality and total cost measures of care.

• Excellent problem-solving and interpersonal abilities.

• Proven analytical skills with a capacity to develop innovative, comprehensive, value-based strategic solutions.

• Ability to lead and supervise teams in collaborative, matrixed environments while meeting budget and timeline objectives.

• Ability to sell consulting services and cultivate strong executive-level client relationships.

• A bachelor's degree from an accredited institution is required.

• Proven leadership in achieving outcomes in healthcare consulting strategy and transformation projects.

• Proficiency in Microsoft Office Suite, including Word, Excel, PowerPoint, and MS Project.

• Strong verbal and written communication skills.

• Knowledge of Medicaid managed care operational program components, such as MMIS, eligibility and enrollment, capitation payments, quality performance, and care coordination.

• Willingness to travel up to 50%.

• Extensive experience in managed care, payer strategy, healthcare negotiations, benchmarking, pricing, contract review, analytics, and transformations.

• Experience with CDM optimization, revenue rebalancing, managed care benchmarking, price transparency, strategic pricing, and automated analytics platforms.

• Understanding of EBITDA improvement, turnarounds, technology innovations, operating model redesign, financial performance, and foundational healthcare processes.

• Experience collaborating with healthcare systems, hospitals, physician organizations, and multi-site healthcare entities.

🏝️ Benefits

• Medical, Rx, Dental & Vision Insurance.

• Personal and Family Sick Time & Company Paid Holidays.

• Position may qualify for a discretionary variable incentive bonus.

• Parental Leave and Adoption Assistance.

• 401(k) Retirement Plan.

• Basic Life & Supplemental Life Insurance.

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts.

• Short-Term & Long-Term Disability Insurance.

• Student Loan PayDown program.

• Tuition Reimbursement, Personal Development & Learning Opportunities.

• Skills Development & Certifications.

• Employee Referral Program.

• Corporate Sponsored Events & Community Outreach.

• Emergency Back-Up Childcare Program.

• Mobility Stipend.

• Flexible benefits package.

• Flexible work arrangements.