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Director-Strategy and Value Transformation Payer Reimburseme

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Job Details
Job Order Number
Company Name
Physical Address

Chicago, IL 60684
Job Description


Guidehouse is a leading management consulting firm serving the public and commercial markets. We guide our clients forward towards new futures that build trust in society and your professional skills along the journey. Join us at Guidehouse.


Navigant (Guidehouse Company)’s Healthcare Practice strives to be the premier independent management consulting practice assisting senior level healthcare executives deal with their core business challenges. The Healthcare Payer Executive Consultant is experienced in areas of health care policy and program design and implementation, economics, financial and accounting analyses, regulatory systems and information management. Successful candidates may work with our clients to develop, evaluate, and implement new health care delivery and payment systems.


+ Performing business analysis and design through healthcare industry-based methodologies

+ Providing Payer expertise specifically in Medicare Advantage, operations, quality, reimbursement, compliance, STARS and payment transformation to maximize results for Payer and Health Plan clients.

+ Developing business-based solutions to address Quality and Reimbursement based business initiatives and problem statements

+ Aiding team in report creation and presentation, and quality control of all deliverables

+ Develop, test and implement business processes, capabilities, architectures and operational transaction activities that improve outcomes in Payer operations

+ Assist in all engagement administrative functions related to communicating changes in work processes to identify process breakdowns and prioritize issues affecting client performance improvement

+ Lead engagement management functions including communication and coordination of work effort of large teams of consultants and client personnel

+ Lead in the identification, pursuit and close of new business opportunities both with new clients and follow-on work at existing clients

+ Keep up-to-date on trends and regulatory changes and requirements impacting the healthcare industry



+ 15+ years of previous work experience in the health care industry with the majority of those years for Health Plans and Payers, preferably in a consulting capacity or consulting firm with a strong track record of leading to results

+ 8+ yrs. Medicaid and/or Medicare Payer strategy and operations expertise that translates to tangible client results that maximize quality, reimbursements and efficiencies.

+ Proven ability to generate consulting revenue greater than $2+ million/year

+ Excellent quantitative analysis skills using and structuring data to model and drive insight, particularly in the areas of: Quality, STARS, and reimbursements results

+ Ability to lead multiple concurrent engagements to timeline, scope and budget by using strong project management skills and client relationships skills.

+ Working knowledge of Word, Excel, PowerPoint, and Access as well as the ability to conduct research through use of the internet and other information sources

+ Bachelors Degree from Accredited College Required- Masters Degree Preferred

+ The ability to travel 50% + weekly

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.


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 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

To view full details and how to apply, please login or create a Job Seeker account.