Part-Time/Project-Based Senior Consultant: Health Plan Services (Part C)
Location: Rolling Meadows, Illinois (Remote)
Introduction
Discover a world of endless possibilities at Gallagher Benefit Services, where you’ll have the power to shape the future of workplaces across industries. As a member of our team, you become the driving force behind positive change, helping clients build environments where employees thrive. Embrace the opportunity to impact lives, unlock potential, and create a legacy of remarkable transformation.We believe that every candidate brings something special to the table, including you! So, even if you feel that you’re close but not an exact match, we encourage you to apply.
Overview
BluePeak Advisors, a Division of Gallagher Benefit Services is a consulting organization that specializes in providing compliance and operational consulting to MA-PD Plans and other ancillary providers and delegates. While much of the work is audit-based and focuses on the CMS Program Audit process and protocols, BluePeak also supports many other project-based process improvement initiatives that assist Plans, delegates and ancillary services providers in achieving operational compliance.
How you’ll make an impact
BluePeak is seeking an experienced clinician who has held leadership roles in MA-PD health plans with a preference for candidates who have worked with Special Needs Plans (SNPs) and MMPs to join our growing Part C consulting practice.This exciting and fast-paced role is responsible for providing subject matter expertise on operational and compliance areas of Medicare Part C to effectively support BluePeak client projects. This position will support multiple client engagements as assigned which may include:
- Subject matter expertise in an operational function of Medicare Part C (ODAG, UM, SNP)
- Ability to review, interpret and implement state and federal guidance
- Extensive familiarity with CMS Program audit process, universes and protocols in the areas of CPE, ODAG and SNP-MOC, MMPCC and SARAG to confirm operational compliance with guidance.
- Experience developing and managing quality programs including NCQA accreditation, HEDIS, Quality and Stars
- Expert understanding of compliant and effective medical management and utilization management process including appeals and grievances
- Ability to develop, review and score SNP-MOC documents for quality and completeness and compliance to NCQA and CMS standards
- Ability to problem-solve in ambiguous situations and apply knowledge and experience to make decisions and recommendations for client business problems.
Requirements:
- Bachelor’s degree, RN with a minimum of ten (10) years government, health care, or quality profession (equivalent combination of education and experience considered.
- Must have strong Microsoft Office Suite skills. Advanced skills in Word, Excel and PowerPoint required
- Experience with Medicare and/or Medicaid requirements, CMS audits, Medicare health plan and required
- Must have strong verbal and written communication skills.
- Individual should be detail oriented with strong organization, prioritization and analytical skills with the ability to work independently.
- Must work well under tight timelines and adapt quickly to change in a fast-paced, team-oriented, and high-growth environment.
APPLY FOR THIS POSITION
Part-Time/Project-Based Senior Consultant: Health Plan Services (Part C)
Thank you for your interest in the Part-Time/Project-Based Senior Consultant for Health Plan Services (Part C) position. Please provide the information below and we will contact you to schedule a call if interested. This link will remain active until the position has been filled.