Guidehouse Associate Director - RN Utilization Management - Healthcare Segment in Augusta, Maine
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.
We are seeking an Associate Director RN with leadership experience in Utilization Management (UM) with payers, and/or delegated entities. Additional provider experience in the inpatient and/or ambulatory environment is desired. Ideally has other expertise including Quality, Care Management, and Chronic Condition Management. Other experience is behavioral health or post-acute desired but not required. Consulting experience desired.
Ideal candidate is a RN leader with Utilization Management (UM) and Care Management (CM) experience with payers and/or providers. At least 5 years of experience. Consulting experience preferred but not required. Quality, Care management, Chronic condition experience, particularly in the inpatient and ambulatory environment is desired. Other experience in behavioral health, post-acute, or care transformation desired. Ideally has experience across payers and providers.
Able to assess, design, and implement Utilization Management, Quality Management, Care Management, and Chronic Condition Management with payers and providers. Understanding of post-acute care and behavioral health is preferred.
Demonstrates an understanding of evolving reimbursement models, including commercial payers, Medicaid and Medicare.
Understands qualitative and quantitative information to build client capabilities and appropriately determine priority areas of opportunity; able to interpret data effectively.
Identifies, develops and evaluates opportunities for growth and development to drive total cost of care
Understands NCQA standards, regulatory and compliance requirements related to Utilization Management, Population Health and Quality.
Collaborates with internal and external entities to improve process standards to reduce medical costs across the service delivery system (hospital, provider and post-acute settings).
Assures alignment between medical management programs, regulatory, compliance and accrediting bodies.
Ability to effect measurable outcomes relative to clinical program development and identification of appropriate care
Serve as a subject matter expert to client and project team, assuming responsibility to develop knowledge of team
Works effectively on a multidisciplinary team.
Demonstrates the ability to lead and manage projects.
Demonstrates flexible, positive, clear interpersonal and communication skills with ability to facilitate the exchange of information within all levels of GH has well as a payor/provider organizations.
A minimum of two years of consulting experience in the provider setting and/or subject matter described above
Active RN license
Bachelor’s degree from an accredited Nursing Program
Minimum 5 years of experience in UM and CM with payers, providers, and delegated entities
A minimum of two years of management experience
NCQA accreditation experience
Proficient in Excel, Word, and PowerPoint skills and ability to independently produce documents
Experience with data analysis to drive change in medical management programming
Strong experience in building strategic relationships with payers and community
Strong clinical background is required
Knowledge of specific regulatory and managed care requirements.
Ability and willingness to do work related travel up to 75-80%
Graduate degree from an accredited Nursing Program
Other clinical areas of expertise such as behavioral health, post-acute, and clinical transformation
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 candidates virtually from EST, CST, PST time zones 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.
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.
Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
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
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