Managing Consultant - Healthcare Compliance, Disputes, & Forensics

Navigant Research   •  

Los Angeles, CA

Industry: Professional, Scientific & Technical Services

  •  

5 - 7 years

Posted 112 days ago

Practice Information

Navigant’s Healthcare Payer Compliance, Disputes, and Forensics practice assists many of the largest national health plans and regional plans to comply with the complex regulatory and policy requirements associated with government programs including Medicare Advantage and Part D, Medicaid, the Affordable Care Act (ACA) and others. Our services fall into the three categories of Compliance and Audit, Disputes and Investigations, and Operations and Systems consulting.

Responsibilities

The Managing Consultant will participate and lead various consulting engagements by applying their industry and subject matter expertise related to government healthcare programs including Medicare, Medicaid, Special Needs Model of Care, ACA, and other health care related programs by performing research, analysis, audit, and client deliverable development and presentations while maintaining the Navigant quality standards and strategic goals. 

The Managing Consultant will assist health plans and other clients with developing and implementing corporate and specialized compliance and audit programs. 

Additional responsibilities will include:

  • Performing research into key compliance and clinical concepts required for government programs
  • Working with data analytics and other professionals to design analyses of various clinical and administrative data and key performance indicators
  • Participating in and leading projects related to compliance program design and implementation as well as audits of various health plan and operational areas
  • Managing junior level consultants on projects
  • Performing process reviews of operational and clinical areas in conjunction with other team members
  • Developing client deliverables including written and oral reports and supporting documentation such as policies and procedures and work flows
  • Documenting engagement activities and conclusions 
  • Preparing and presenting as requested to client leadership team 
  • Developing innovative approaches / solutions to client needs
  • Serving as a project manager including developing effective work plans, budgets, and staffing plans

Qualifications

 

  • BS/BA from an accredited college/university in a business-related field or liberal arts program
  • MBA preferred
  • 5+ years of healthcare managed care industry or consulting experience, or a combination of healthcare managed care industry and consulting experience
  • Healthcare Compliance and Audit, Disputes and Investigations, and Operations and Systems industry/consulting experience
  • Knowledge of government programs related laws and regulations and accreditation standards (CMS Medicare and Medicaid)
  • Supervisory experience
  • Experience working in a fast-paced complex environment
  • Strong written and oral communication and presentation skills 
  • Strong knowledge of Microsoft Word, Excel, and PowerPoint
  • Travel (east coast and west coast) is required (approximately 50%)