Manager Managed Care Contracting Jobs (NOW HIRING)

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What You Will Do:

The desired Partner, Managed Care Advisory will have the opportunity to drive significant revenue enhancement and strategic repositioning for healthcare clients. This leader will be responsible for helping organizations identify and capture millions in potential revenue through comprehensive managed care solutions, including commercial rate benchmarking and payer price transparency analytics. The role involves navigating complex contract negotiations, particularly with challenging payers, and developing strategies that can transform a client's financial performance. This leader's impact will extend beyond immediate financial gains, potentially helping distressed healthcare organizations improve their margin and market positioning by addressing critical managed care contract challenges.

The Partner, Managed Care Consulting is a senior leadership position within the Guidehouse Healthcare Practice, specifically focused on leading and driving growth for the Healthcare sector. This partner will be responsible for bringing and developing a book of business and have an oversight of ongoing project delivery solution development and management of teams across multiple concurrent client engagements across our managed care vertical. This role is critical to the success of the overall practice growth strategy, and will have responsibility for originating, closing, and managing clients, leading consulting teams, and ensuring the delivery of high-quality revenue cycle strategies and programs. This leader must be both strategic and operational, possessing deep knowledge and experience on how health systems work. They must successfully develop and execute against the vision for Managed Care services, including driving consulting projects that outline transformative initiatives to contain costs, enhance revenues, and lay out initiatives for execution across the firm for impact. Tying these initiatives to metrics and KPIs to show both revenue increases and cost containment success is crucial to the role. They must be experts in selling and delivering advisory work that assists healthcare organizations in optimizing performance, enhancing efficiency and ensuring compliance within industry regulations. This role is key in shaping and driving consulting opportunities across the entire managed care life cycle. This Partner will be key in helping build out the Managed Care practice, helping develop and mentor consultants in new methods to enhance performance improvement and drive impactful transformation initiatives leveraging the Guidehouse platform.

The ideal candidate will co-lead the managed care practice that has the strong analytical staff, benchmarking and price transparency processes, as well as the reputation in the managed care place to advance the practice and work alongside highly experienced industry leaders to make meaningful change for clients served across 150+ markets.

Primarily the responsibilities for this role include:

• Drive revenue enhancement, risk mitigation, and strategic repositioning for healthcare clients, with a focus on improving revenue and margins

• Manage the full managed care contracting cycle, including analytics, strategy preparation, negotiations, and post-contract implementation

• Develop and execute comprehensive managed care solutions, including commercial rate benchmarking, payer price transparency analytics, and contract negotiations

• Bring new clients to the table, with a partner-level revenue target of $8 million or higher

• Provide strategic insights across the healthcare ecosystem, including working with C-suite executives to transform revenue and market positioning

• Lead business development of advisory pursuits within the territory/market.

  • Activities include originating new consulting opportunities, driving assessments in the front end, current v. future state performance, expanding and extending current advisory engagements, relationship-based selling to new clients, leading RFP responses, and representing the firm at business development-related conferences

• Lead advisory and delivery teams on high-impact revenue cycle transformation client engagements within territory/market.

  • Activities include: client relationship management, consulting delivery execution, project financial management, risk/quality management, and client satisfaction management

• Build a book of business through senior client relationship management by finding, closing and delivering Managed Care growth initiatives

• Manage teams consisting of consulting experts and advisory personnel to cover key accounts

• Responsible for contract growth, and uncovering and assisting in originating and capturing new opportunities that land and expand revenue cycle programs with clients

• Manage transaction deals sizes ranging from $500K to multi-million dollars annually with pull through to managed services that are multi year

• This role will also support the Next Gen Payer-Provider healthcare horizontal joint initiatives between the managed care and the payer practice

• Key to this role will be able to cross sell other guide house services to broaden accounts and exposure in the marketplace parentheses (e.g. access performance excellence, strategy digital etc)/

• Provide expertise and deep experience in Managed Care to evolve deal constructs, teaming opportunities, and portfolio evolution

• Lead client management and growth in Managed Care by leveraging design, development, and implementation skills to advise and guide clients to best options

• Interface, manage, and expand relationships with client CEOs, CFOs, CTOs and other senior executives to demonstrate how solutions set the strategy for enhancing operational efficiency, financial health, and patient care quality.

• Own and build critical business and industry relationships, both internally and externally

• Advise clients based on knowledge of operations best practices, industry trends, market happenings, and the newest technology innovations

• Team and collaborate across the firm to drive maximum value for clients

What You Will Need:

• Previous executive consulting or industry leadership with Medicaid OR Medicare/Medicare Advantage (STARS and quality), accountable care organization, or patient centered medical home highly desirable

• 15+ years professional experience in a combination of the following:

  • ACO leadership

  • Managed care

  • Health Plan or Payer leadership

  • Health Plan executive level contract management

  • IT/Data management

  • Quality management

  • Client-facing healthcare consulting role

  • Health policy analysis and health economics research.

  • Risk predication and adjustment methods, and performance-based procurement,

  • Quality and total cost measures of care for Federal, State, and health plans who participate in the Affordable Care Act, Medicaid, and Medicare programs.

• Superb problem-solving and interpersonal skills Demonstrated use of analytical skills that found innovative, holistic, value based strategic solutions

• Demonstrated ability to lead and supervise staff in a collaborative and matrixed team environment to achieve budget and timeline goals

• Ability to sell consulting and building strong client relationships at the executive level, demonstrated by persuading boards and C-suites of Government Health State Agencies, Health Plan and Payor organizations to action

• Bachelor's degree from accredited school required

• Demonstrated leadership achieving outcomes in healthcare consulting focused strategy and transformation projects

• Proven verbal and written communication skills, including the ability to persuade senior management or Knowledge of Medicaid managed care operational program elements including MMIS, eligibility and enrollment, captivation payments, quality performance and care coordination

• Travel up to 50% as the job requires

What Be Nice to Have:

Sales and Commercial Excellence

• Demonstrated experience in selling Managed Care contracts for projects that support large hospital systems and physician organizations, as well as community hospitals, academic medical centers, and mid to large-size regional healthcare providers.

• Deep experience originating front end deals and getting new logos by positioning best practices, industry trends and leveraging existing relationships and developing new ones

• A consulting sales leader that is constantly scouring for new opportunities, leveraging their experience and relationships in the managed care space to sell assessments and shape consulting deals for the entire Managed Care life cycle (strategy, technology, operations, etc)

• A demonstrated sales record of consistent achievement of $8-10 million+ annually within Healthcare Managed Care Advisory and skills, relationships and market knowledge to build a book of business quickly

• Player/Coach that drives all client facing and business development activities for selling advisory and positioning digital and managed services end to end projects.

  Leverages strategy, financial and operational knowledge to serve as a consulting leader to sell advisory to healthcare executives using learned experiences and best practices, the latest industry trends, regulation changes, and market movements to compel them to act.

• Utilize proper sales operations discipline (e.g. pipeline analytics, offering collaterals, tracking scorecards) to performance manage the team

• Can coach strategy consultants on best practices for developing and growing executive client relationships

• Can create a high-energy environment among the consulting team that drives enthusiasm, optimism, and a relentless focus on solving client problems, winning deals, and achieving performance metrics

• Can originate opportunities, oversee sales and delivery, and engage in closing entry point projects to position land and expand opportunities across the revenue cycle continuum.

Managed Care Domain Knowledge

• Deep payer strategy and advisory experience in the drivers that can enhance optimizing operations, financial health, and patient outcomes while navigating complex regulatory environments

• A deep experience developing and executing negotiation strategies for provider and payer healthcare clients to improve their financial posture from both a revenue enhancement and cost containment perspective

• Deep experience in either industry and/or consulting driving optimization work, including analytics around benchmarking to help inform fact-based negotiation strategy and positions

• Negotiation experience from strategy through execution in the healthcare ecosystem internally and externally including partners to make improvements

• Experience in CDM optimization, revenue rebalancing, managed care benchmarking, price transparency, strategic pricing, managed care strategy, contract language review and automated analytics platform for benchmarking type services will be crucial.

• A deep understanding across the healthcare system environment to lay out roadmaps for broad transformations and restructuring work to sell discrete projects that satisfy strategic goals

• An expert in areas such as EBITDA improvement, turnarounds, tech innovation, operating model redesign, financial performance, and foundational processes in a healthcare system.

• Deep understanding of industry trends towards greater price transparency and the technology enabled solutions to support an evolving marketplace as well as other analytical advancements that impact clients

• Deep strategic consulting in large scale transformations that impact operational performance and implement technology transformations and strategic planning

• Experience partnering with healthcare systems, hospitals, physician organizations, and multi-site healthcare entities, reinforced by a deep knowledge of key players in the market

• Ability to tailor solutions that address the unique challenges of the healthcare industry driving performance and patient outcomes

Delivery Excellence

• Track record of advising clients on payer revenue and contract yield leading practices, clinical operations, technology strategy, and innovative care, leveraging deep industry insights to drive performance improvement to ensure its proper delivery.

• Demonstrated experience in developing strategic roadmaps and ensuring consulting teams deliver the plans to drive financial and operational performance improvements that help organizations streamline processes, reduce costs, and enhance efficiency.

• The ideal candidate will come with a reputation for selling and delivering Managed Care transformations that made an everlasting impact to healthcare clients and can be replicated Deep experience in creating compelling deliverables and work products that clients have used to drive performance improvement initiatives with impact.

• Ideal candidates will have a record of relationship building, selling and delivering roadmaps of work, strong employee and team satisfaction metrics, focusing on an employee experience focused management approach

• Ability to manage multiple pursuits and overseeing and coaching teams on internal operations and methodologies for effective programs.

• Proven ability to sell and deliver across the entire Guidehouse portfolio

• Focused on Managed Care and ensuring projects are delivered on time and on budget

• Can leverage delivery insights into addressing problems before they happen and looking for cross-sell opportunities

Client Management

• Has C-Level relationships and can build others with senior executives at healthcare entities, including Partners, to serve with excellence and quality

• Develops account planning programs for pro...