Director, Managed Care

Guidehouse•Chicago, IL

About The Position

The Director, Managed Care Advisory is a senior leadership role within Guidehouse’s Healthcare Practice. This leader drives growth, manages clients and consulting teams, and ensures delivery of high-quality managed care strategies and programs. The role focuses on helping healthcare organizations improve financial performance and market positioning through managed care contracting, payer negotiations, performance improvement, and transformation initiatives, with results tied to revenue and cost-containment metrics and KPIs. The Director will build the Managed Care practice, develop and mentor consultants, originate and deliver client engagements, and grow senior client relationships. Responsibilities include leading advisory pursuits and transformation engagements, expanding accounts, cross-selling Guidehouse services, and collaborating across the firm, including on Next Gen Payer-Provider initiatives. The position manages deals ranging from $500,000 to multi-million-dollar annual engagements, potentially with multi-year managed-services work. Travel is required up to 50%.

Requirements

At least 10 years of professional experience in one or more of the following areas: ACO leadership, managed care, health plan or payer leadership, executive-level health plan contract management, IT/data management, quality management, client-facing healthcare consulting, health policy analysis, or health economics research.
At least 10 years of work experience in healthcare management and/or strategy, or equivalent consulting experience.
Previous executive consulting or industry leadership experience involving Medicaid or Medicare/Medicare Advantage is highly desirable; experience with STARS and quality, ACOs, or patient-centered medical homes is also identified as desirable.
Experience with risk prediction and adjustment methods, performance-based procurement, and quality and total-cost-of-care measures for federal, state, and health plans participating in Affordable Care Act, Medicaid, and Medicare programs.
Excellent problem-solving and interpersonal skills.
Demonstrated analytical skills and ability to develop innovative, holistic, value-based strategic solutions.
Demonstrated ability to lead and supervise staff in a collaborative, matrixed team environment and meet budget and timeline goals.
Ability to sell consulting services and build strong executive-level client relationships, including persuading boards and C-suites of government health agencies, health plans, and payer organizations to take action.
Bachelor’s degree from an accredited school.
Demonstrated leadership in achieving outcomes on healthcare consulting strategy and transformation projects.
Proficiency in Microsoft Office Suite, including Word, Excel, PowerPoint, and MS Project.
Proven verbal and written communication skills, including the ability to persuade senior management.
Knowledge of Medicaid managed care operational program elements, including MMIS, eligibility and enrollment, capitation payments, quality performance, and care coordination.
Ability to travel up to 50%.
Experience developing and executing negotiation strategies for provider and payer healthcare clients to improve financial posture through revenue enhancement and cost containment.
Experience driving optimization work and using benchmarking analytics to inform fact-based negotiation strategies and positions.
Experience with healthcare negotiation from strategy through execution, including work with internal and external stakeholders and partners.
Experience in CDM optimization, revenue rebalancing, managed care benchmarking, price transparency, strategic pricing, managed care strategy, contract-language review, and automated analytics platforms for benchmarking.
Deep understanding of healthcare systems and ability to develop roadmaps for broad transformations and restructuring aligned with strategic goals.
Expertise in areas such as EBITDA improvement, turnarounds, technology innovation, operating-model redesign, financial performance, and foundational healthcare-system processes.
Understanding of price-transparency trends and technology-enabled solutions, along with analytical advancements affecting clients.
Experience with large-scale strategic consulting transformations that improve operational performance, implement technology transformations, and support strategic planning.
Experience partnering with healthcare systems, hospitals, physician organizations, and multi-site healthcare entities, along with knowledge of key market players.
Ability to tailor solutions to healthcare-industry challenges to improve performance and patient outcomes.

Nice To Haves

Demonstrated experience selling Managed Care contracts for large hospital systems, physician organizations, community hospitals, academic medical centers, and mid- to large-sized regional healthcare providers.
Experience originating front-end deals and winning new clients by positioning best practices and industry trends, leveraging existing relationships, and developing new ones.
A record of consistent annual sales achievement of $8 million to $10 million or more in Healthcare Managed Care Advisory, with the skills, relationships, and market knowledge to build a book of business quickly.
Player-coach experience driving client-facing and business-development activities for advisory sales and positioning digital and managed-services projects end to end.
Ability to use strategy, financial, and operational knowledge, industry trends, regulatory changes, market movements, and best practices to sell advisory services to healthcare executives.
Experience coaching strategy consultants in executive client-relationship development.
Experience creating an energetic consulting-team environment focused on solving client problems, winning deals, and achieving performance metrics.
Deep payer strategy and advisory experience optimizing operations, financial health, and patient outcomes in complex regulatory environments.
Deep understanding of healthcare industry trends and technology-enabled solutions related to price transparency and evolving market needs.

Responsibilities

Manage the full managed care contracting cycle, including analytics, strategy preparation, negotiations, and post-contract implementation.
Develop and execute managed care solutions, including commercial rate benchmarking, payer price transparency analytics, and contract negotiations.
Bring new clients to the firm and achieve a partner-level revenue target of $8 million or higher.
Provide strategic insights across the healthcare ecosystem and work with C-suite executives to transform revenue and market positioning.
Lead business development for advisory pursuits within the assigned territory or market.
Lead advisory and delivery teams on high-impact transformation client engagements.
Build a book of business through senior client relationship management, finding, closing, and delivering Managed Care growth initiatives.
Manage teams of consulting experts and advisory personnel supporting key accounts.
Drive contract growth and originate and capture opportunities that expand revenue-cycle programs with clients.
Manage transaction deal sizes from $500,000 to multi-million dollars annually, including opportunities to pull through multi-year managed services.
Support Next Gen Payer-Provider joint initiatives between the managed care and payer practices.
Cross-sell Guidehouse services to broaden accounts and marketplace exposure.
Provide Managed Care expertise to evolve deal constructs, teaming opportunities, and portfolio offerings.
Interface with, manage, and expand relationships with client CEOs, CFOs, CTOs, and other senior executives.
Build and maintain key internal and external business and industry relationships.
Advise clients using knowledge of operations best practices, industry trends, market developments, and technology innovations.
Collaborate across the firm to maximize value for clients.
Drive client-facing and business development activities, originate opportunities, oversee sales and delivery, and help close entry-point projects that enable land-and-expand work across the revenue-cycle continuum.
Use sales operations practices such as pipeline analytics, offering collateral, and tracking scorecards to manage team performance.
Coach consultants on developing and growing executive client relationships and foster a high-energy, performance-focused consulting team.