Director - Healthcare Value Transformation - Strategic Rate Setting - Remote Location

Navigant - Remote3.5

Full-time
Practice Information

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.

Responsibilities

We are currently seeking individuals interested in leading a growing Strategic Rate Setting practice. Individuals should be focused on growing a career in healthcare, particularly related to state government funding strategies (i.e., Medicaid), fee schedule development, transition to new payment models and more broadly commercial and government payers.

The successful candidate will:
Serve as engagement Director for healthcare payment and pricing projects, payment incentive models, hospital payment adequacy analyses, federal compliance for Medicaid programs, and federal revenue enhancement programs
Play a critical role in shaping the growth strategy and service offering for this practice

Assist clients in the design, development, and implementation of health care payment strategies and rate setting
Evaluate impact of changes in Federal policy and determine required updates to state policy
Oversee detailed data analysis of large health care claims and cost report datasets
Oversee data analytics related to managed care plan quality, payment methodology, rate development, risk adjustment, or other metrics related to clinical or financial measurement
Lead engagement updates and regularly present project milestones to practice leadership and client executives
Facilitate training and information sharing between state Medicaid agency staff and contractors, providers, and managed care plans
Facilitate meetings with diverse groups of stakeholders, including state agencies and vendors
Serve at the subject matter expert for the practice
Recruit, direct and develop staff in the development of analytics, research, and client deliverables
Assure quality work product and review all deliverables
Train staff on technical issues to foster institutionalization, functionality, and replication
Perform project manager role on projects and build client relationships
Identify sales opportunities and lead the RFP and sales process in order to grow business and client relationships
Qualifications

The following minimum qualifications are required for Associate Director candidates:

Strong track record for leading and growing a practice through networking, client relationship management and strategic business development capabilities
Advanced knowledge and experience with the application of methods for risk adjustment, reserving, pricing, and forecasting for health insurance
Demonstrated proficiency in utilizing the CMS-2552-10, Medicare acuity, and Medicaid quality scores in assessing hospital performance and hospital reimbursement through Medicaid
Successful experience setting inpatient and outpatient rates for hospitals (e.g., DRG and/or EAPG pricing methodology), as well as RUG-based analysis and payment methodology for nursing homes
A sound appreciation for and ability to speak on the impact of Medicaid managed care on hospitals, by classification (rural, urban, teaching, critical access, etc.)
Ability to engage in relationship initiation and cultivation with state Medicaid leaders and/or hospital industry leaders.
Understanding of hospital-based financing for Medicaid payments (IGT, CPE, assessments, etc.)
Ability to see the broader opportunities across the entire Value Transformation practice
Solid communication skills, including ability to speak to C-suite executives in a manner that engenders cooperation, trust, and buy-in
15+ years of previous work experience in the health care industry or with a consulting firm
10-15 years of experience working with Medicaid or other health care claims data
Proficient in Microsoft Office Suite
Superior written and oral communication skills
Project management and client relations experience
Business development experience (e.g., identifying sales opportunities, assisting with sales process)
Ability to work overtime and travel, as necessary
Mental/Physical Requirements

Frequently communicates with clients and coworkers and must be able to share information effectively
Strong conceptual, as well as quantitative and qualitative analytical skills
Flexibility and responsiveness in managing multiple projects in sometimes high-pressure situations simultaneously
Self-motivator with ability to work independently
Plan, direct, and coordinate work activities of others
Frequently travels by airplane, train or car as necessary to perform work at another location

EEO/C&B Statement

The company offers competitive compensation packages including an incentive compensation plan, comprehensive medical/dental/life insurance, 401(k) and employee stock purchase plans.

Navigant does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Navigant and Navigant will not be obligated to pay a placement fee.

Navigant 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.

Navigant 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.