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Public/Payer Managing Consultant Medicaid Managed Care

at Guidehouse in Dover, Delaware, United States

Job Description

Overview

Guidehouse is a leading global provider of consulting services to the public and commercial markets with broad capabilities in management, technology, and risk consulting. We help clients address their toughest challenges and navigate significant regulatory pressures with a focus on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that prepare our clients for future growth and success. The company has more than 10,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company, led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit: www.guidehouse.com.

Responsibilities

We are currently seeking a Managing Consultant with experience and knowledge of Medicaid managed care and Medicaid health plan operations to work as part of a state Medicaid agency’s managed care team. The successful candidate will: · Assist state Medicaid agencies and its sister agencies (such as Aging, Mental Health, Public Health), in the design, implementation and operation of Medicaid managed care programs · Assist state agencies in the evaluation of Medicaid managed care organizations performance relative to contract requirements, performance improvement targets and common industry practices · Develop administrative code, federally-required documents, requests for proposals, policy and program manuals, and other policy materials · Research and undertake the implementation and completion of special projects related to implementation and improvement of managed care programs · Facilitate training and information sharing between state Medicaid agency staff and contractors · Facilitate meetings with diverse groups of stakeholders · Communicate with managed care organizations · Provide oversight and monitoring of managed care programs and managed care organizations to ensure compliance · Research and stay abreast of states’ developments in Medicaid managed care programs and policies, including programs that serve particularly vulnerable populations or cover complex services · Analyze identified issues or problems and review reports to identify areas for improvement for managed care organizations in particular, and the managed care program overall · Document and communicate updates and findings · Provide subject matter expertise · Assure quality work product

Qualifications

· 5-8 years of experience working in a Medicaid health plan or in a state Medicaid agency; preferably in a role which required interaction across business units or departments · Basic knowledge of the Code of Federal Regulations (CFR), Social Security Act (SSA), Medicaid State Plans, and other documents as they relate to the operation of Medicaid agencies · Ability to train staff on technical issues in order to foster institutionalization, functionality, and replication · 4+ yrs. of clinical quality managemment · 2+ yrs. Experience working to design and implement agency consolidation

+ BS/BA Degree from an Accredited University RN or MD desired.

Preferred but not required: · Experience conducting Medicaid health plan audits or performance reviews · Experience working in commercial payers with Medicaid managed care · Strong communication and writing skills · Experience managing or monitoring managed care programs in a Medicaid agency is a plus · Managed Care Vaccine distribution Experience.

Additional Requirements

+ The successful candidate must not be subject to employment restrictions from a former employer (such as a non-compete) that would prevent the candidate from performing the job responsibilities as described.

+ This position is open to candidate virtually from EST, CST, PST time zone as well as AZ, UT.

+ Due to our contractual requirements and an Executive Order from the White House, every federal government employee and onsite federal contractor will be asked to attest to their vaccination status. In the interest of health and safety during the continued unprecedented COVID-19 pandemic, anyone who does not attest to being fully vaccinated will be required to follow CDC guidelines which may include (subject to specific contractual requirements): wearing a mask on the job no matter their geographic location, physically distancing from all other employees and visitors, complying to any screening testing requirements. This requirement will apply to Guidehouse employees who work onsite for the federal government.

Disclaimer

About Guidehouse Guidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, 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. 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. Rewards and Benefits 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 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 Tuition Reimbursement, Personal Development & Learning Opportunities Skills Development & Certifications Employee Referral Program Corporate Sponsored Events & Community Outreach Emergency Back-Up Childcare Program Position may be eligible for a discretionary variable incentive
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Job Posting: JC193954713

Posted On: Oct 03, 2021

Updated On: Nov 12, 2021