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Guide Healthcare
Guide Healthcare
51 – 200 Employees
HealthcareHealthcare InsuranceRecruitment
Guide Healthcare operates across allied health services and healthcare recruitment, with a focus on supporting and treating older adults. Established in 2018, the company works with clients, partners, and teams to deliver practical value in the healthcare sector while taking a different approach to service provision and recruitment. Its work may be relevant to professionals interested in healthcare, allied health, recruitment, and services for older people.
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Client Business Manager - Healthcare Operations, Illinois Remote

Guide Healthcare is seeking a remote Client Business Manager to support value-based healthcare clients in Illinois. The role oversees delegated services, compliance, reporting, escalations, and operational performance.

USUnited StatesILIllinois
$65,000 – $70,000 / year
RemoteFull-timeMiddleSeniorEnglish RequiredManager

Description

  • Support client success through onboarding, operational support, and service delivery
  • Work virtually with clients, health plans, and internal teams in a fully remote setting
  • Manage onboarding and service delivery from go-live through steady-state operations
  • Build relationships with client administrators, network providers, and management teams
  • Oversee delegated services across Eligibility, UM, PHM, Claims, Quality, CX, and Credentialing/Provider Relations
  • Maintain primary accountability for delegated-function performance
  • Ensure compliance with regulatory requirements and client contracts
  • Prepare monthly delegated-services reports and quarterly executive review materials
  • Assist with URAC, HCAPA, and health-plan pre-delegation audit preparation
  • Analyze, track, and report operational data and performance metrics
  • Manage eligibility, capitation, and reconciliation processes while resolving discrepancies with Finance and Eligibility
  • Support implementations, scope expansions, platform transitions, network builds, and accreditation renewals
  • Monitor SLA performance, address gaps, lead remediation, and report progress to clients and leadership
  • Lead client operations meetings and participate in UM committees, JOCs, and monthly close meetings
  • Conduct client check-ins, satisfaction reviews, and quarterly executive business reviews
  • Monitor CSAT and NPS against annual targets
  • Manage escalations involving claim denials, authorization, eligibility, provider complaints, roster discrepancies, and payments
  • Support renewals through SLA restructuring, PMPM negotiation input, scope proposals, and BAA updates
  • Represent Guidehealth at BCBSIL forums and turn regulatory and program changes into operational actions
  • Maintain client contracts, DORs, SOWs, and SLA schedules
  • Contribute to initiatives that improve operational performance
  • Use EMR systems, payer portals, Guidehealth applications, and Microsoft 365 for daily work
  • Partner with internal teams to deliver integrated services and a consistent client experience

Requirements

  • Bachelor’s degree preferred; an Associate degree or equivalent experience may be considered
  • At least three years of experience in healthcare operations, managed care, IPA operations, health plan operations, or a related area
  • Experience owning or substantially contributing to client-facing operational work with responsibility for outcomes
  • Strong verbal and written communication skills
  • Excellent organization with the ability to manage multiple workstreams, deadlines, and deliverables
  • Strong analytical and problem-solving capabilities
  • Ability to independently manage a client portfolio and competing priorities in a fast-paced environment
  • Proficiency with Microsoft 365, including Excel, Word, PowerPoint, Outlook, and Teams
  • Ability to learn and use multiple systems
  • Valid driver’s license and reliable transportation
  • Ability to travel 25% within the Chicago area
  • Experience with delegated services preferred
  • Familiarity with value-based care contracts and PMPM service arrangements preferred
  • Experience with SLA tracking, contract compliance reporting, and health-plan or NCQA/URAC audit preparation preferred
  • Familiarity with claims workflows, 834 eligibility files, capitation reconciliation, and payer portals preferred
  • Experience presenting operational and executive reporting to client leadership preferred
  • Basic knowledge of EMR systems and healthcare data platforms preferred
  • Ability to work during stated hours with internet service providing at least 100 Mbps download and 10 Mbps upload

Benefits

  • Fully remote work arrangement
  • Medical, dental, and vision coverage
  • 401(k) plan with a 3% employer match on the employee’s 6% contribution
  • Life and disability insurance
  • Voluntary life insurance options
  • Employee Assistance Program
  • Paid time off plans
  • Paid parental leave
  • Learning and development resources
  • Required work equipment provided at no cost
  • Commitment to equal opportunity employment

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