Navigant Consulting Inc Director- Healthcare Value Transformation focused State Rate Setting - Multiple Locations in Indianapolis, Indiana

Navigant Consulting, Inc. (NYSE: NCI) is a specialized, global professional services firm that helps clients take control of their future. Navigant’s professionals apply deep industry knowledge, substantive technical expertise, and an enterprising approach to help clients build, manage and/or protect their business interests. With a focus on markets and clients facing transformational change and significant regulatory or legal pressures, the Firm primarily serves clients in the healthcare, energy and financial services industries. Across a range of advisory, consulting, outsourcing, and technology/analytics services, Navigant’s practitioners bring sharp insight that pinpoints opportunities and delivers powerful results. More information about Navigant can be found at

Navigant’s Healthcare Practice strives to be the premier independent management consulting practice assisting senior level healthcare executives deal with their core business challenges. The Navigant Consulting Healthcare Value Transformation practiceis responsible for helping payers and providers develop go-to-market strategies and operational plans to transform their business, payment and delivery models to create high value , more sustainable, affordable and high quality services. Our professionals are 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. Listed below are some of the areas in which our health care professionals provide services:

• Policy design, development and implementation

• Payment methodologies and rate development

• Managed care program design and implementation

• Health care reform

• Findings, assurances and rate studies

• Insurance and claims management

• Healthcare information technology (HIT)

• Clinically Integrated Networks-- Market analysis, organizational design, network development, physician alignment.

• Payment Transformation--- Develop payment and funds flow distribution models that incentivize and reward high quality of care.

• Totatl Medical Expense Management (TME)---Implementation of care delivery models that manage care across the continuum.

Our clients rely on our team for an integrated solution that drives improved performance and competitive advantages in their markets, in a way that enables senior executives to manage their business to new provider sponsored risk models. See How Far Impact Can Reach.

This role can be based in any of the following locations: Chicago, IL; Atlanta, GA; Washington, DC; New York, NY; Minneapolis, MN; Indianapolis, IN


  • Responsibilities for the Director are broadly defined and are expected to increase as quickly as aptitude is demonstrated. This is a highly challenging position that draws heavily upon all of the analytical, creative, and interpersonal skills essential to assist states and the federal government as they evolve through reform. It will demand you to assume complete ownership of key project tasks and schedules in carrying out substantial business analyses and delivering high quality, client-ready work.Directors must demonstrate considerable poise and business maturity to perform effectively and add value in the client environment.The position has business development responsibilities including soliciting and responding to proposals to develop business with other state and federal agencies as well as provide subject matter expertise and advice in the pursuit for other engagements.The responsibilities include:•Senior level guidance and support in the development and management of select government health solutions customer relationship•Direction of a consulting staff for proposals and some project work•Client relationship management•Define improvement goals. Ensure quality and performance goals are established and measured•Help the practice meet revenue and profit objectives by developing net new and expanded services revenue through thought leadership, best practices, client proposal assistance, sales support, client deliverables and project oversight within the government health space (state and federal)•Lead client proposal and solution processes including: opportunity identification, proposals, and client presentations

Content Deliverables Responsibilities:

  • Work with Navigant’s Payer team on Medicaid, Medicare Advantage and Part D rate setting projects across a variety of states, health plans, MCOs and other clients

  • Be a key contributor to strong data analysis focused Medicaid Rate Setting projects

  • Review regulatory and policy guidance and apply to healthcare Compliance and reimbursement issues

  • Conduct End-to-End process improvement projects to support Medicaid and Medicare Rate Setting assisting with: participating physicians and hospitals, aggregation, filtering, to insure proper compliance and submission for Federal and state governments using a variety of data layouts

  • Document healthcare claims and encounter data flow and facilitate closure of any gaps

  • Assist with risk adjustment audit projects in close coordination with other data analytics, compliance, and clinical team members

  • Analyze revenue impact from clinical diagnosis coding and demographic factors on medicaid clients

  • Develop clear reports and data analysis result tables and summaries

  • Provide consistent flawless Rate Setting work product to the state and apply it to provider institutions

  • Ability to demonstrate strong communication skills both written and oral

  • Ability to recognize and manage risks for the firm and client

  • Ability to utilize creative problem solving techniques

  • Previous executive consulting or industry leadership with Medicaid OR Medicare/Medicare Advantage (STARS and quality), accountable care organization, or patient centered medical home highly desirable

  • 10+ years professional experience Rate Setting for States Medicaid Health plans including a combination of the following:

  • Medicaid Managed care strategy

  • Medicaid leadership, Medicaid Rate Setting leadership for a Health Plan or Actuarial leadership for rate setting managed care

  • Client-facing healthcare consulting role

  • Health policy analysis and health economics research.

  • Risk predication and adjustment methods, and performance based procurement,

  • Quality and total cost measures of care for Federal, State, and health plans who participate in the Affordable Care Act, Medicaid, and Medicare programs.

  • Proven verbal and written communication skills, including the ability to persuade /advise senior management and state leadership to define rates that conform to policy and deliver the highest level of health services to members.

  • Superb problem-solving and interpersonal skills

  • Demonstrated use of analytical skills that found innovative, holistic, value based strategic solutions

  • Demonstrated ability to lead and supervise staff in a collaborative and matrixed team environment to achieve budget and timeline goals

  • Experience selling consulting and building strong client relationships at the executive level, demonstrated by persuading boards and C-suites of Government Healthe State Agencies, Health Plan and Payor organizations to action for at least three years at a minimum of $2 million annually

  • Master’s degree in business, healthcare, or related field strongly preferred; Bachelors required

  • Demonstrated leadership achieving outcomes in healthcare consulting focused strategy and transformation projects

  • Proficiency in MS Office Suite – Word, Excel, PowerPoint, MS Project

  • 10+ years of work experience in healthcare management and/or strategy, or equivalent consulting experience. 10+ years of work experience with payor in Medicare or Medicaid (preferred) rate setting or economic leadership

  • Frequently communicates with clients and coworkers and must be able to share information effectively

  • Strong conceptual, as well as quantitative and qualitative analytical skills

  • Flexibility and responsiveness in managing multiple projects in sometimes high-pressure situations simultaneously

  • Self-motivator with ability to work independently

  • Plan, direct, and coordinate work activities of others

  • Frequently travels by airplane, train or car as necessary to perform work at another location

The company offers competitive compensation packages including an incentive compensation plan, comprehensive medical/dental/life insurance, 401(k) and employee stock purchase plans.

Navigant does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Navigant and Navigant will not be obligated to pay a placement fee.

Navigant 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.