Job Description

As a Consulting Manager at ProspHire you will be a Firm leader, client delivery expert and mentor to junior staff. At a fast growing, 60+ person management consulting firm, this means you’ll use your problem-solving and resource management skills to manage growth and profitability of growing health plan accounts. You’ll cultivate and build relationships at all levels of a client organization to earn “trusted advisor” status while also serving as a mentor. You’ll get in the trenches and stand shoulder-to-shoulder with our health plan clients to solve their people, process and technology challenges.

The ideal candidate will have a strong background in HEDIS/Stars and experience leading a quality improvement program in accordance with the strategic goals of a health plan.

Requirements

· Engage executive leadership on HEDIS/Stars strategy, make recommendations to address areas of concern and provide status on projected results

· Collaborate with health plan leadership to develop processes to measure and collect data for HEDIS/Stars indicators

· Implement a quality improvement program in accordance with the strategic goals of a health plan; Analyze and identify trends to develop improvement strategies and action plans for quality rating systems (HEDIS, QRS, Stars) across all lines of business

· Manage quality initiatives and work cross-functionally with clinical and technical teams to develop the tools, processes and reporting required to ensure compliance with a complete and accurate coding and billing function

· Provide timely monitoring of HEDIS/Stars program data submissions: CAHPS, HOS, HEDIS, etc.

· Establish and communicate protocols and standards of care for the Medicare Advantage, Medicaid and ACA member populations while providing intervention guidelines based on current population health needs

· Establish professional relationships with vendor partners, regulators, internal stakeholders and community agencies to facilitate quality processes

· Closely follow CMS guidelines and translate into business strategies and tactics

· Plan and lead client engagements; Facilitate buy-in of proposed solutions from clients; Define timing, manage resources and direct on-time, quality production of deliverables

· Summarize and deliver information to clients through highly polished documentation and presentations; Communicate status, issues and risks to leadership

· Develop and maintain relationships with key client decision makers; Lead, articulate and negotiate business cases for Firm’s service offerings; Consistently meet and exceed sales and managed revenue requirements

· Appropriately forecast and manage engagement risk, budget and resources with the Firm and client

· Mentor and coach junior team members, conduct performance reviews and support the Firm’s overall recruitment and retention efforts

· Serve as a member of the Firm’s Leadership Team; Represent the Firm positively by b uilding and maintaining strong relationships with professionals and team members at all levels

Qualifications:

· A bachelor’s degree in a relevant field required; Master’s degree in healthcare or MBA preferred

· Deep understanding of Medicare, Stars and HEDIS programs

· Experience managing programs and interventions through a full Stars cycle

· 8+ years’ professional experience in Health Plans, Payers or Government Programs, or a mix of a few years’ industry experience combined with consulting at the manager level

· PMP or Six Sigma Black Belt certification preferred

· Consulting experience preferred

· Authorization to work in the U.S.

· Ability to travel up to 50% of the time, if necessary; Our Firm has national clients

Benefits

· Competitive compensation, plus bonus

· Medical, vision and dental

· 401k with 4% match

· Flexible time off and paid holidays

· Paid parental leave

· $500 annual wellness subsidy

· Modern and cool workspace in Downtown Pittsburgh

· Snacks (of course)

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