Marsh McLennan
Senior Medical Consultant - Medicaid Managed Care Quality Specialist
Marsh McLennan, Phoenix, Arizona, United States, 85001
Senior Medical Consultant I (Medicaid Managed Care Quality Specialist)
We are seeking a talented individual to join our Government Human Services Consulting (GHSC) team at Mercer. This role will be based anywhere near a Mercer office, and it is a hybrid role with a requirement of working at least three days a week in the office. (Note: the primary GHSC office locations are in Phoenix, Minneapolis, and Atlanta; these are the preferred geographical locations for this position.) Mercer is seeking a managed care quality specialist with deep experience and knowledge related to Medicaid managed care programs. What can you expect? We specialize in assisting State and Federal government-sponsored programs in becoming more efficient purchasers of health services. We bring the best critical thinkers forward in helping our clients explore and address today's complex healthcare issues. Our clients are primarily State Medicaid and Children's Health Insurance Program (CHIP) agencies and related state agencies responsible for Medicaid and CHIP fee-for-service and managed care programs. This role provides you with an opportunity to work in a team environment to ensure client recommendations contain multiple points of view and consider up-to-date clinical best practices. Beyond the in-depth training provided, new employees are included on client teams immediately, providing unique opportunities to learn while helping team members with critical workloads and making a difference to our clients. As part of Mercer, the Government Human Services Consulting team offers its expertise within a smaller business atmosphere. What's in it for you? Help support vulnerable populations through the development of meaningful clinical policy and monitoring of the quality of Medicaid programs. Contribute to a multi-disciplinary team solving some of health care's biggest challenges. Benefit from excellent growth/advancement opportunities and strong peer support. Work for a global company with excellent benefits and a dynamic culture. Participate in available engagement and new-hire events, community volunteering activities, and social impact events. Having fun in the work you do comes from being a part of a team and contributing to its success. We believe that diversity makes us better and we are deliberate in building a diverse workforce. We will count on you to: Participate in multiple project teams as a subject matter expert in Medicaid managed care quality programs and operations. Our projects are diverse and include strategic planning; program design; managed-care procurement; performance-based contracting; managed care readiness and post implementation reviews; managed care reporting, monitoring and performance management/External Quality Review; focused studies; healthcare analytics; and advanced clinical support for actuarial analyses. Actively lead and support a multi-disciplinary team to complete specific projects related to External Quality Review assessment of quality, timeliness, and access to health care services provided by a managed care organization (MCO), prepaid inpatient health plan (PIHP), prepaid ambulatory health plan (PAHP) to Medicaid or CHIP recipients. Coordinate and effectively support or manage project teams, ensuring the team is within budget, on time, and producing work consistent with the scope of the project. Be responsible for motivating and encouraging team members while contributing to a positive and collaborative team culture. Identify client needs and potential project risks and support implementation of solutions. Work closely with the Project Leader to track and document day-to-day milestones. Follow protocols for peer review and consistent quality assurance. Maintain timely and effective communication with clients, project team members, and the internal client manager. Coordinate with clients and sector leaders to support development of new business, including contributing to the proposal process (e.g., drafting technical material, peering/editing material, supporting budget development); conducting sales presentations and identifying opportunities for expanded revenue with existing clients. What you need to have: License as a Registered Nurse (RN) or Social Worker (SW) required (within continental U.S.) Minimum eight years of relevant experience required Medicaid experience in a clinical or quality role required Experience working with HEDIS measures and EQRO Protocols Ability to manage, motivate, and mentor more junior level staff Strong mathematical skills; command of Excel a plus What makes you stand out: Expertise with special populations such as children's health, long-term care, maternal-infant health, geriatrics Experience with clinical informatics and/or experience using and interpreting health care data to build better health programs
We are seeking a talented individual to join our Government Human Services Consulting (GHSC) team at Mercer. This role will be based anywhere near a Mercer office, and it is a hybrid role with a requirement of working at least three days a week in the office. (Note: the primary GHSC office locations are in Phoenix, Minneapolis, and Atlanta; these are the preferred geographical locations for this position.) Mercer is seeking a managed care quality specialist with deep experience and knowledge related to Medicaid managed care programs. What can you expect? We specialize in assisting State and Federal government-sponsored programs in becoming more efficient purchasers of health services. We bring the best critical thinkers forward in helping our clients explore and address today's complex healthcare issues. Our clients are primarily State Medicaid and Children's Health Insurance Program (CHIP) agencies and related state agencies responsible for Medicaid and CHIP fee-for-service and managed care programs. This role provides you with an opportunity to work in a team environment to ensure client recommendations contain multiple points of view and consider up-to-date clinical best practices. Beyond the in-depth training provided, new employees are included on client teams immediately, providing unique opportunities to learn while helping team members with critical workloads and making a difference to our clients. As part of Mercer, the Government Human Services Consulting team offers its expertise within a smaller business atmosphere. What's in it for you? Help support vulnerable populations through the development of meaningful clinical policy and monitoring of the quality of Medicaid programs. Contribute to a multi-disciplinary team solving some of health care's biggest challenges. Benefit from excellent growth/advancement opportunities and strong peer support. Work for a global company with excellent benefits and a dynamic culture. Participate in available engagement and new-hire events, community volunteering activities, and social impact events. Having fun in the work you do comes from being a part of a team and contributing to its success. We believe that diversity makes us better and we are deliberate in building a diverse workforce. We will count on you to: Participate in multiple project teams as a subject matter expert in Medicaid managed care quality programs and operations. Our projects are diverse and include strategic planning; program design; managed-care procurement; performance-based contracting; managed care readiness and post implementation reviews; managed care reporting, monitoring and performance management/External Quality Review; focused studies; healthcare analytics; and advanced clinical support for actuarial analyses. Actively lead and support a multi-disciplinary team to complete specific projects related to External Quality Review assessment of quality, timeliness, and access to health care services provided by a managed care organization (MCO), prepaid inpatient health plan (PIHP), prepaid ambulatory health plan (PAHP) to Medicaid or CHIP recipients. Coordinate and effectively support or manage project teams, ensuring the team is within budget, on time, and producing work consistent with the scope of the project. Be responsible for motivating and encouraging team members while contributing to a positive and collaborative team culture. Identify client needs and potential project risks and support implementation of solutions. Work closely with the Project Leader to track and document day-to-day milestones. Follow protocols for peer review and consistent quality assurance. Maintain timely and effective communication with clients, project team members, and the internal client manager. Coordinate with clients and sector leaders to support development of new business, including contributing to the proposal process (e.g., drafting technical material, peering/editing material, supporting budget development); conducting sales presentations and identifying opportunities for expanded revenue with existing clients. What you need to have: License as a Registered Nurse (RN) or Social Worker (SW) required (within continental U.S.) Minimum eight years of relevant experience required Medicaid experience in a clinical or quality role required Experience working with HEDIS measures and EQRO Protocols Ability to manage, motivate, and mentor more junior level staff Strong mathematical skills; command of Excel a plus What makes you stand out: Expertise with special populations such as children's health, long-term care, maternal-infant health, geriatrics Experience with clinical informatics and/or experience using and interpreting health care data to build better health programs