Guide Healthcare ittifoqdosh tibbiy xizmatlar va sog‘liqni saqlash sohasida xodimlarni ishga jalb qilish yo‘nalishlarida faoliyat yuritadi hamda keksalarga ko‘maklashish va ularni davolashga e’tibor qaratadi. 2018-yilda tashkil etilgan kompaniya sog‘liqni saqlash sektorida amaliy qiymat yaratish uchun mijozlar, hamkorlar va jamoalar bilan ishlaydi, xizmat ko‘rsatish va ishga qabul qilish jarayonlariga o‘zgacha yondashuvni qo‘llaydi. Uning faoliyati sog‘liqni saqlash, ittifoqdosh tibbiy xizmatlar, ishga jalb qilish va keksalar uchun xizmatlarga qiziqadigan mutaxassislar uchun dolzarb bo‘lishi mumkin.
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.
Tavsif
- 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
Talablar
- 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
Imtiyozlar
- 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