Director, Managed Care

Job Family:

Travel Required:

Clearance Required:

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 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

• Proficiency in MS Office Suite – Word, Excel, PowerPoint, MS Project

• 10+ years of work experience in healthcare management and/or strategy, or equivalent consulting experience.

• 3+ years of work experience with payor in Medicare or Medicare Operations strategy or operations leadership, or financial strategy /ops or contracting strategy is highly preferred

• 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 proper client coverage to go deep and wide (expand the

• “pipe and pie”) in serving clients holistically

• Brings clients new ideas based on the market, industry and technology trends proactively to keep them ahead of achieving their goals

• Bring strong provider and payer market relationships with senior executives and be able to gain traction rapidly on selling new business

• Ideal candidates will lead with empathy and have an extensive set of relationships, capabilities, and approaches to bring firm offerings to client needs in an authentic, mission-driven, and clientservice-focused manner 

• Track record of building and expanding client partnerships through the development and delivery of new advisory services solutions

• Ability to build new processes and solutions to improve client satisfaction, service quality and market penetration

Scale & Execution 

• Experience selling a roadmap of managed care services that start with consulting and advisory to position larger deals across the Guidehouse portfolio

• Demonstrated experience selling and delivering large, concurrent consulting projects that made impact and delivered results to replicate at other healthcare organizations.

• Track record of consistent achievement of building and growing a book of business of $8-$10 million annually within healthcare Managed Care

• Disciplined operator who performance-manages their consulting team with rigor and discipline and develops best practices and processes for constant improvement

• A KPI-driven leader that monitors the health of the business and takes proactive action for improvements and innovation

Culture Fit & Leadership 

• A strategic thought leader, expert in Managed Care advisory, driven to improve financial and operational improvement in healthcare. 

• Personable, humble, confident and experienced proactive leader able to function in a matrix

• Charismatic visionary with high EQ, high IQ, and low ego

• A strong leader and communicator able to guide and mentor their team to successful outcomes

• A resilient consulting expert who has the proven experience to work through client opportunities and issues to get results, improve ways of working, and deliver quality results

  Demonstrated experience grooming the following generations of leadership 

• Proven experience building and transforming teams, driving service and quality excellence

• Ability to articulate mature hiring and management philosophies as well as leading best practice methodology development to improve overall consulting performance. 

• Ability to navigate and lead through ambiguity

• Highly credible, leadership polish, and winning instincts

• Collaborative team player that works well to best serve clients and Guidehouse across the firm 

Personal characteristics 

The ideal candidate must possess strong people skills and the ability to function effectively in a matrix management environment. They should be adaptable, capable of working across different organizational structures, and not rigidly hierarchical. The leader must have excellent interpersonal abilities who can lead and develop team members. They must have high emotional intelligence who can collaborate effectively. Some important details include:

• Strategically minded, operationally inclined, and action-oriented

• Market facing deal maker and delivery/operational leader

• A team builder with executive presence

• Charismatic visionary with low ego/high EQ

• Resilient, roll-up-the-sleeves ‘doer’ that ‘gets things done’

• Innovative out-of-the-box critical thinker

• Natural collaborator that reaches across the firm to maximize impact

• Driven to improve revenue cycle management performance

• Provide and create a high-energy environment among the healthcare team that drives enthusiasm, optimism, and a relentless pursuit of solving client problems, winning deals, and achieving targeted metrics

• Inspired by strong teamwork and collaboration and working with great people 

What We Offer:

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.

Benefits include:

• 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

• 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

About Guidehouse

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.

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.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or guidehouse@myworkday.com.  Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse.  Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact recruiting@guidehouse.com. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties.

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.