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Senior Consultant, Managed Care Services

FTI Consulting 119 reviews Charlotte, NC

FTI Consulting - 30+ days ago

Job Description

ABOUT THE COMPANY:

FTI Consulting, Inc. is a global business advisory firm dedicated to helping organizations protect and enhance enterprise value in an increasingly complex legal, regulatory and economic environment. With more than 3,800 professionals located in most major business centers around the world, we work closely with clients every day to anticipate, illuminate, and overcome complex business challenges in areas such as investigations, litigation, mergers and acquisitions, regulatory issues, reputation management and restructuring. Our professionals are some of the most experienced leaders in their field and our workforce includes numerous PhDs, MBAs, CPAs, CFEs, JDs, and technologists with expertise across a broad range of industries. Since our founding in 1982, clients have turned to us for high-stakes issues that require specialized expertise.

FTIs Healthcare practice has more than 200 professionals including healthcare executives, clinicians, physicians, strategists, economists and consultants. From assessments through implementation, FTI focuses on delivering measurable results to the income statement and balance sheets of our clients. FTI is the preferred provider of healthcare performance improvement, clinical integration, transaction advisory, forensic / litigation, and economic consulting. FTIs Healthcare Practice offers the full breadth of operational disciplines and performance improvement services. If you are interested in becoming part of a fast growing company and helping shape its future, read on.

ABOUT THE OPPORTUNITY:

FTIs Health Solutions Practice aids our clients (hospitals, insurers, life science companies, physician practices, and others) in preparing their organizations to execute in an environment of unprecedented change. This practice within FTI has grown at an average of 20% annually over the past four years, and is poised for continued growth at this pace.

The Senior Consultant will be assisting legal counsel and corporate clients who are primarily large for profit and non-profit managed care plans with their Medicare and Medicaid contracts; and Pharmacy Benefit Managers with regulatory compliance and operations engagements within the Managed Care and pharmaceutical industries.

PRIMARY DUTIES:

  • Supervise large complex client engagements by developing and executing effective work plans, delegating and overseeing work of junior team members when appropriate, and having ongoing personal contact with clients to keep them informed on the progress of engagements
  • Develop and maintain client budgets and status reports
  • Develop new products and client engagement tools based on managed care industry trends
  • Analyze healthcare and managed care industry trends, perform research into new regulatory and policy requirements, and train more junior team members on these issues
  • Develop and implement database and other analytic tools for client engagements
  • Establish relationships with new health plan clients as well as nurture relationships with former clients available for new work
  • Train and oversee junior team members and perform quality reviews of their work
  • Create high quality and innovative client work products and presentations
  • CLIENT ENGAGEMENTS INCLUDE:

  • Medicare and Medicaid Compliance Program Review and implementation
  • Mock government audits for Medicare and Medicaid health plans
  • Independent Review Organization (IRO) duties pursuant to a Corporate Integrity Agreement
  • Corporate Investigations
  • Enterprise Risk Assessments involving the Healthcare Industry
  • Large scale medical and pharmacy claims and enrollment data analysis for health plans
  • Strategic and operational planning analyses for major health plans
  • Pharmacy Benefit Manager audits of claims and formulary rebates
  • Operations performance improvement consulting
  • BASIC QUALIFICATIONS:

  • Bachelors degree.
  • Minimum of 4 years of health plan compliance, operations, or audit experience involving the Healthcare Industry
  • Must be willing to travel weekly, with a minimum expectation of 50% annually
  • PREFERRED SKILLS:

  • Bachelor's degree in Finance, Economics, Accounting, Statistics, Social Sciences, Health Care Administration or nursing is preferred.
  • Large scale data analysis with complex medical and pharmacy claims or other health care data skills
  • Graduate level degree (e.g., MBA, Masters in Health Care Administration or Public Policy, or JD)
  • CPA Certified Public Accountant
  • Working knowledge of Medicare Advantage and Part D plans and Medicaid regulatory and policy requirements
  • Course work or degree in Statistics, Mathematics or Computer Sciences
  • Experience in various types of SOX , HEDIS, or government audits a plus
  • Advanced skills involving SQL, MS Access or SAS
  • POSITION CLASSIFICATION: Exempt

    FTI Consulting is an Equal Opportunity Employer



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