Healthcare Partner, Managed Care Consulting

The role

The Partner, Managed Care Advisory will drive significant revenue enhancement and strategic repositioning for healthcare clients. This leader will help organizations identify and capture millions in potential revenue through comprehensive managed care solutions, including commercial rate benchmarking and payer price transparency analytics.

• Navigate complex contract negotiations with challenging payers
• Develop strategies to transform client financial performance
• Bring new clients to the table with a partner-level revenue target of $8 million or higher
• Lead business development of advisory pursuits within the territory/market
• Manage consulting teams on high-impact revenue cycle transformation client engagements
• Build a book of business through senior client relationship management
• Manage teams consisting of consulting experts and advisory personnel
• Uncover and assist in originating and capturing new opportunities
• Support Next Gen Payer-Provider healthcare horizontal joint initiatives
• Collaborate across the firm to drive maximum value for clients

Qualifications

• Previous executive consulting or industry leadership with Medicaid OR Medicare/Medicare Advantage (STARS and quality), accountable care organization, or patient centered medical home
• 15+ 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
• Performance-based procurement
• 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 build 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
• 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, captivation payments, quality performance and care coordination

What be nice to have

• Sales and Commercial Excellence
• 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
• A 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
• 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
• 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
• 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
• 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
• A 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
• 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 payer revenue and contract yield leading p