Managing Consultant – Healthcare – Value Transformation State Medicaid Programs
US National – Employee, Full-Time
Managing Consultant – Healthcare – Value Transformation State Medicaid Programs – Remote Location
Job ID: 10179
Location: Remote Location
Full/Part Time: Full-Time
The healthcare industry is undergoing a generational shift from Fee For Service (curve 1) to Pay For Value (curve 2) payment and delivery models. Our Value Transformation (VT) practice is responsible for helping payers and providers develop go-to-market strategies and operational plans to transform their business, payment and delivery models to create high value, more sustainable, affordable and high-quality services. Our team has an integrated platform of services to help our clients achieve their goals, including:
Clinically Integrated Networks: Market analysis, organizational design, network development, physician alignment.
Payment Transformation: Develop payment and funds flow distribution models that incentivize and reward high quality of care.
Total Medical Expense Management (TME): Implementation of care delivery models that manage care across the continuum.
Our experience includes:
Work in over 90 markets nationally provides us tremendous national experience and local market insight to value-based care models
Experience with over 20 ACOs, including Pioneer ACOs and MSSPs, including managing the start-up for 6 MSSPs
Facilitated over 25 commercial payer/provider ACO contracts/partnerships centered on shared savings, shared risk and performance-based payment
Assists over 150 hospitals with CMS bundling applications, implementation and performance measurement
Development of numerous CIN’s, including several regional / statewide organizations across multiple health systems
Utilize our NextGeneration analytic toolkit, with over 1B claims, to provide a wide array of analytics, modeling and reporting services for leading payers and providers to budget and manage margin and total medical cost trend Assists several large providers and payers, including Medicaid agencies, with the design and implementation planning of new payment and delivery models (e.g., ACOs, medical homes, etc.)
Our clients rely on our team for an integrated solution that drives improved performance and competitive advantages in their markets, in a way that enables senior executives to manage their business to new provider sponsored risk models. See How Far Impact Can Reach.
We are currently seeking a Managing Consultant with prior healthcare State Payer strategy consulting experience or a blend of relevant healthcare payer industry and consulting experience. The successful candidate will:
Take a multidisciplinary approach to addressing projects in one or more of the practice’s following focus areas:
Clinical Managed Care Strategy (Post-Acute Care, Service Lines, Care Continuum)
New Revenue Models (specifically focused on State Government clients Pricing Strategy)
Development of alternative value-based care models
Accountable care organization operations including process improvement, Lean Six Sigma skills in a payer environment
Medical management design and operations (e.g., utilization review, medical management, Medicare Advantage, case management)
Accountable for client relationships and managing day-to-day program work with a focus on the payer and health plan strategy and operations.
Participate in leading internal team and external client meetings. With state-sponsored health plans (Medicaid/Medicare/CHIP).
Present results and updates to Navigant leadership and clients, and manage projects on time, within budget and set objectives.
Manage internal multi-workstream project teams to deploy the right expertise to meet objectives.
Oversee senior consultants and consultants to achieve deliverables.
Assist where necessary with data acquisition, integration and analysis to support a wide range of provider …
Consulting , State & Local Government , Insurance , Medical & Health , Analyst