Healthcare Partner, Managed Care Consulting

Job Family: Strategy & Transformation Consulting Travel Required: Up to 50% Clearance Required: None 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. Responsibilities 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 vs. 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 deal sizes ranging from $500K to multi-million dollars annually with pull through to managed services that are multi-year. Support the Next Gen Payer-Provider healthcare horizontal joint initiatives between the managed care and the payer practice. Cross-sell other Guidehouse services to broaden accounts and exposure in the marketplace (e.g., access performance excellence, strategy digital). 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. Qualifications (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 of 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, health economics research, risk prediction and adjustment methods, performance-based procurement, quality and total cost measures of care for federal, state, and health plans participating 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 build strong client relationships at the executive level, demonstrated by persuading boards and C-suites of government health state agencies, health plan, and payer organizations to action. Bachelor’s degree from an 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. Knowledge of Medicaid managed care operational program elements including MMIS, eligibility and enrollment, capitulation payments, quality performance, and care coordination. Travel up to 50% as required. 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. Consulting sales leader constantly scouring for new opportunities, leveraging 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). 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 best practices, latest industry trends, regulation changes, and market movements. Utilize proper sales operations discipline (e.g., pipeline analytics, offering collaterals, tracking scorecards) to perform manage the team. Coaches strategy consultants on best practices for developing and growing executive client relationships. Creates 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. Originates opportunities, oversees sales and delivery, and engages in closing entry-point projects to position land-and-expand opportunities across the revenue cycle continuum. Deep payer strategy and advisory experience in drivers that can enhance optimizing operations, financial health, and patient outcomes while navigating complex regulatory environments. Experience developing and executing negotiation strategies for provider and payer healthcare clients to improve financial posture from both revenue enhancement and cost containment perspectives. 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 services. Expertise in EBITDA improvement, turnarounds, tech innovation, operating model redesign, financial performance, and foundational processes in a healthcare system. Deep understanding of industry trends toward greater price transparency and technology-enabled solutions supporting an evolving marketplace. Strategic consulting in large-scale transformations impacting operational performance and implementing technology transformations and strategic planning. Experience partnering with healthcare systems, hospitals, physician organizations, and multi-site entities, reinforced by deep knowledge of key market players. Ability to tailor solutions addressing unique challenges of the healthcare industry driving performance and patient outcomes. What We Offer Annual salary range: $310,000.00–$520,000.00. Competitive compensation and a flexible benefits package reflecting a commitment to a diverse and supportive workplace. Medical, Rx, Dental, and Vision Insurance. Personal and Family Sick Time & Company Paid Holidays. Eligibility for a discretionary variable incentive bonus. Parental Leave and Adoption Assistance. 401(k) Retirement Plan. Basic and Supplemental Life Insurance. Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts. Short-Term and Long-Term Disability. Student Loan Paydown Tuition Reimbursement, Personal Development & Learning Opportunities. Skills Development & Certifications. Employee Referral Program. Corporate Sponsored Events & Community Outreach. Emergency Back-Up Childcare Program. Mobility Stipend. Equal Opportunity Statement Guidehouse is an Equal Opportunity Employer—Protected Veterans, Individuals with Disabilities 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. #J-18808-Ljbffr US101 Guidehouse Inc.