Guidehouse Managing Consultant Public Payer Clinical Quality in Des Moines, Iowa
Guidehouse is a leading global provider of consulting services to the public sector and commercial markets, with broad capabilities in management, technology, and risk consulting. By combining our public and private sector expertise, we help clients address their most complex challenges and navigate significant regulatory pressures focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that help our clients outwit complexity and position them for future growth and success. The company has more than 12,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit www.guidehouse.com.
We are currently seeking a Associate Director with experience and knowledge of Medicaid managed care and Medicaid health plan operations to work as part of a state Medicaid agency’s managed care team. The successful candidate will:
· Assist state Medicaid agencies and its sister agencies (such as Aging, Behavioral Health, Public Health, Social Services), in the design, implementation and operation of Medicaid managed care programs
· Serve as engagement manager for healthcare industry clients - directing staff i n executing analytics, research, and preparing complex, high quality deliverables that provide state and commercial Medicaid managed care programs with accurate strategic, operational and clinical support that improves client understanding and fosters change.
· Manage data analytics related to managed care plan quality, payment methodology, rate development, risk adjustment, or other metrics related to clinical or financial measurement
· Assist state agencies in the evaluation of Medicaid managed care organizations performance relative to contract requirements, performance improvement targets and common industry practices
· Develop draft administrative code, federally-required documents, requests for proposals, policy and program manuals, and other policy materials
· Research and undertake the implementation and completion of special projects related to implementation and improvement of Medicaid and other HHS programs
· Facilitate training and information sharing between state agency staff and contractors
· Facilitate meetings with diverse groups of stakeholders, including community members and program participants
· Communicate with managed care organizations and other vendors
· Research and stay abreast of states’ developments in Medicaid policies, including programs that serve particularly vulnerable populations or cover complex services
· Analyze identified issues or problems and review reports to identify areas for improvement, including for programs where managed care or other outsourcing models are in place.
· Document and communicate updates and findings
· Provide subject matter expertise
· Assure quality work product
· Lead project management office (PMO) functions and oversee consulting business activities including labor and budget tracking, financial reporting, invoicing and client-facing project management tasks.
· 7-10 years of experience working in a Medicaid health plan, state Medicaid or other Health and Human Services unit, community based organization or other health and human service setting; preferably in a role which required interaction across business units or departments
· Basic knowledge of the Code of Federal Regulations (CFR), Social Security Act (SSA), Medicaid State Plans, and other documents as they relate to the operation of Medicaid agencies
· Ability to train staff on technical issues in order to foster institutionalization, functionality, and replication
· 6+ yrs. of initiative management experience leading efforts that resulted in demonstrated improvement in population and/or community health outcomes
· 5+ yrs. Experience working to improve operations, compliance, organizational effectiveness, innovation and/or diversity/equity and inclusion.
· 2+ yrs. using network, experience/knowledge and data to influence executive decision makers at the state health agency level on substantial change programs.
Preferred but not required:
· Experience addressing the needs of aging and disability populations, delivering chronic disease management and/or behavioral health / substance use disorder services
· Experience working in commercial payers with Medicaid managed care, focusing on high risk members, dual-eligible members, etc.
· Experience engaging and reporting to high-level state officials, presenting to Legislative bodies, etc.
· Experience managing or monitoring managed care programs in a Medicaid agency is a plus
· Understanding of change management principles and/or certification in change management is a plus
· Experience writing winning proposals and/or grant applications that incurred revenue, is a plus
· Project manager certification (e.g. PMP) is a plus
The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.
This position is open to candidate virtually from EST, CST, PST time zones as well as AZ, UT.
Applicants must be currently authorized to work in the United States for any employer.
No sponsorship is available for this position.
Due to our contractual requirements, to be eligible for this role, you must be fully COVID-19 vaccinated at time of hire.
Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.
Rewards and Benefits
Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave and Adoption Assistance
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Progra
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