Director, Managed Care

Job Family:

Operational Effectiveness Consulting

Travel Required:

Up to 50%

Clearance Required:

None

What You Will Do:

The Director, Managed Care Advisory will have the opportunity to drive significant revenue enhancement and strategic repositioning for healthcare clients. 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 Director, Managed Care Consulting is a senior leadership position within the Guidehouse Healthcare Practice and an experienced negotiator leading and driving growth for the Healthcare sector. This role is critical to the success of the overall practice growth strategy, and will have responsibility for managing clients, leading consulting teams, and ensuring the delivery of high-quality strategies and programs. Tying these initiatives to metrics and KPIs to show both revenue increases and cost containment success is crucial to the role.

This leader 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. Primarily the responsibilities for this role include:
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.

Lead advisory and delivery teams on high-impact transformation client engagements within territory/market. 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 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
10+ 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…