Guidehouse

• Manage submission, review, and approval of applications for child care funds by states, territories, and tribes, including preparing, reviewing, and managing correspondence to grantees for the purpose of assessing grantee performance and compliance with Federal regulations as a regional liaison for designated cycles. • Prepare guidance, technical assistance resources, and other training materials to support program operations oversight of grantee implementation and administration activities. • Train staff and grantees. • Provide briefings and facilitate meetings and webinars for staff, leadership, grantees, and others. • Collect and analyze data. • Provide information and advice and prepare, update, track, monitor, and report on designated program operations and grantee implementation status, activities, issues, and accomplishments. • Manage databases and spreadsheets to collect, compile, and analyze data. • Develop recommendations for improvements in program operations as identified by data analysis. • Prepare descriptive background and analytical reports, memoranda, and other types of written material on significant issues of legislative and operational concern for senior management, supervisors, team leaders, and staff. • Coordinate, carry out, and monitor special projects and initiatives focused on grantees in the Office of Child Care. • Develop plans for carrying out special projects and initiatives, including determining information and resource needs, key personnel, and time frames. • Work closely with officials at the grantee and national level, as appropriate. • Monitor progress and keep key personnel informed of status. • Assess the impact of outcomes and results. • Coordinate with federal and contract staff to manage and oversee program operations activities. • Provide Office of Child Care regional program stakeholders with regular reports and updates on project and work statuses, as directed.

Clinical Denials and Appeals RN US - Remote (Any location) Full time job requisition id 40382 Job Family: Clinical Appeals Nurse Travel Required: None Clearance Required: None What You Will Do: - Conduct pre‑ and post‑service medical necessity reviews for inpatient, observation, and outpatient hospital encounters using evidence‑based criteria such as InterQual and Milliman Care Guidelines. - Perform retrospective medical record reviews to validate completeness and accuracy of physician and clinical documentation supporting level of care and services rendered. - Identify denial root causes and determine appeal viability based on payer policies, regulatory guidance, and clinical standards. - Prepare, submit, and track clinical appeals, including written appeals. - Collaborate with Patient Access, Case Management, Utilization Management, Coding, and Mid‑Revenue Cycle teams to resolve denials and prevent recurrence. - Research and apply payer‑specific policies, CMS regulations, and contractual language to support appeal arguments. - Track and report denial and appeal outcomes, identify trends, and provide recommendations for process improvement and staff education. - Maintain accurate documentation of all review activities in hospital and payer systems in accordance with compliance standards. What You Will Need: - Current unrestricted Registered Nurse license in the state you reside - Bachelor's degree and 4-6 years of prior relevant experience in acute care clinical experience in hospital setting or Associates Degree and 6-8 years of prior relevant experience in acute care clinical experience in hospital setting (Relevant experience may be substituted for formal education or advanced degree). - Experience in clinical denials, utilization review, case management, or appeals required What Would Be Nice To Have: - Bachelor of Science in Nursing - Master’s degree in Nursing - Experience with InterQual and/or Milliman Care Guidelines, and electronic medical record systems. - Compact State RN License - Experience with inpatient level‑of‑care denials, DRG downgrades, and CMS payer rules. - Strong knowledge of hospital revenue cycle workflows, medical necessity review, and payer regulations. - Excellent analytical, organizational, and written communication skills with the ability to independently manage multiple cases. The annual salary range for this position is $68,000.00-$113,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs. What We Offer: Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace. Benefits include: - Medical, Rx, Dental & Vision Insurance - Personal and Family Sick Time & Company Paid Holidays - Position may be eligible for a discretionary variable incentive bonus - Parental Leave - 401(k) Retirement Plan - Basic Life & Supplemental Life - Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts - Short-Term & Long-Term Disability - Tuition Reimbursement, Personal Development & Learning Opportunities - Skills Development & Certifications - Employee Referral Program - Corporate Sponsored Events & Community Outreach - Emergency Back-Up Childcare Program About Guidehouse Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation. Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco. If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation. All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or guidehouse@myworkday.com. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process. If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse’s Ethics Hotline. If you want to check the validity of correspondence you have received, please contact recruiting@guidehouse.com. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant’s dealings with unauthorized third parties. Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.

• Develop and execute stakeholder engagement, outreach, recruitment, communications, marketing, and partnership strategies that support program goals. • Build and maintain relationships with researchers, publishers, academic institutions, advocacy organizations, healthcare organizations, community groups, and other key stakeholders. • Represent the program at conferences, meetings, workshops, advisory boards, focus groups, and stakeholder forums, delivering presentations and facilitating collaboration. • Coordinate outreach campaigns, community engagement initiatives, social marketing efforts, and digital communications activities to increase awareness, participation, and trust in research programs. • Research best practices in stakeholder engagement, scholarly publishing, communications, recruitment, retention, and partnership development to inform program strategies. • Support dissemination of program information, research findings, and stakeholder communications through effective messaging and content development. • Manage stakeholder databases, engagement records, communications materials, performance metrics, partnership activities, and day-to-day program operations. • Collect, analyze, and report engagement, outreach, and performance data to evaluate effectiveness, identify trends, and recommend improvements. • Develop and coordinate communications materials, marketing collateral, presentations, reports, and stakeholder-facing content in collaboration with leadership and subject matter experts. • Serve as a resource on stakeholder engagement, outreach, communications, recruitment, and partnership-building strategies.

• Lead the delivery of Microsoft platform and Microsoft Business Applications engagements, ensuring high-quality execution from initiation through successful deployment and transition to support. • Oversee project and program delivery across multiple workstreams, managing scope, timeline, budget, risks, dependencies, and customer expectations. • Partner with clients, account teams, and internal delivery teams to define solution approach, delivery plans, governance, and success criteria. • Be accountable for ensuring the overall delivery execution quality of Microsoft Biz Apps engagements in the segment providing oversight and governance. • Build and develop relationships with Microsoft segment and support managing joint sales pursuits. • Maintain awareness of industry best practices and business levers for offerings keeping pace with Microsoft Biz Apps product evolution within the sector. • Build and develop relationship / partnership with segment teams, aligning on sales pursuits, resource capacity and capabilities, and awareness across the industries. • Drive revenue of all Microsoft Biz Apps (Power Platform, SharePoint, and Co-Pilot) offerings across businesses in the segment, with revenue management expectations. • Monitor engagement health, resolve delivery issues, and proactively identify opportunities to improve outcomes, efficiency, and client satisfaction. • Support practice growth by contributing to delivery standards, methodologies, reusable assets, and best practices for Microsoft platform engagements. • Collaborate with leadership to forecast resource needs, manage staffing, and support pursuit and proposal efforts as needed.

• Project Coordinator supporting integrated eligibility, Medicaid, SNAP, or related systems • Provide administrative, coordination, and technical support to the project team across system implementation or modernization efforts • Support onboarding, meeting logistics, environment access, and tool setup (project management, DevOps, document repositories, etc.), along with time-keeping and deliverable tracking • Maintain project documentation, repositories, and technical artifacts (requirements, design documents, configuration management assets, etc.) • Support reporting, including status (defects, risks/issues, release milestones), action item tracking, and general project operations

• Execute manual testing procedures to validate the functionality of the VA Cerner system. • Develop and maintain test cases, test scripts, and test data based on system requirements and specifications. • Identify, document, and track defects using appropriate tools and methodologies. • Collaborate with developers, business analysts, and other stakeholders to understand system requirements and ensure comprehensive testing coverage. • Participate in test planning, test execution, and test reporting activities. • Provide clear and concise feedback on test results and work closely with the development team to resolve issues. • Ensure compliance with testing standards and best practices.

• Lead and manage technical projects from initiation through completion, ensuring delivery on time, within scope, and aligned to business objectives. • Partner with cross-functional teams including engineering, product, operations, and stakeholders to define project scope, milestones, dependencies, risks, and success criteria. • Develop and maintain detailed project plans, timelines, status reports, RAID logs, and communication plans to keep stakeholders informed and projects on track. • Coordinate resources, facilitate meetings, drive issue resolution, and proactively remove blockers to support successful execution. • Track progress against commitments, manage scope changes, and escalate risks or impediments as needed to ensure project delivery. • Support process improvement efforts and help establish project management best practices, tools, and standards across the team. • Contribute to Business Development efforts

• The GIS Solution Architect is the functional and technical authority for the end-to-end ArcGIS Utility Network solution design on a utility GIS modernization program. • Own the ESRI ArcGIS Utility Network solution design: domain network definitions, tier configurations (radial, mesh), terminal assignments, containment associations, junction-edge connectivity rules, and network attribute definitions. • Conduct Fit-Gap workshops comparing SmallWorld GDM schema and G/Technology module data models to ESRI UN target architecture; document design decisions and configuration rationale. • Define network topology validation standards: connectivity tolerance rules, dirty area management, subnetwork validation criteria, and pre-go-live network tracing acceptance tests. • Design and lead iterative mock migration cycles; define validation KPIs — connectivity rate, attribute completeness, tracing correctness, and spatial accuracy — and own defect remediation through go-live.

Role Description The Manager, Notification of Admission (NOA) Services is responsible for the day-to-day leadership, operational oversight, and performance of Guidehouse’s NOA operations. This role manages onshore and offshore Patient Access Representatives and serves as the primary operational liaison between Guidehouse and client stakeholders to ensure timely and accurate admission notifications, proactive denial prevention, and consistent achievement of service-level expectations. The Manager provides hands-on leadership across workforce management, training, quality assurance, SOP development, reporting, and continuous process improvement while ensuring compliance with payer-specific and client requirements. This position requires direct experience performing NOA-related work and leading teams responsible for admission notification activities. As the Manager of NOA Services, you will play a critical leadership role in building high-performing teams, strengthening client relationships, and delivering measurable results for our healthcare partners. What You Will Do: - Directly supervise and support onshore and offshore NOA Patient Access Representative teams. - Assign, prioritize, and monitor daily work queues to ensure timely completion of payer notifications. - Serve as the primary operational liaison between Guidehouse and client departments, including Patient Access, Case Management, Utilization Review, Revenue Integrity, Health Information Management, and Revenue Cycle leadership. - Provide hands-on support for complex accounts, escalations, payer issues, and workflow challenges. - Monitor daily admission volumes, staffing capacity, productivity, and service level performance. - Develop and maintain staffing plans to support client needs and volume fluctuations. - Lead onboarding, training, mentoring, and performance coaching for NOA staff. - Develop, maintain, and continuously improve Standard Operating Procedures, work instructions, and training materials. - Conduct quality assurance reviews and identify opportunities for process improvement. - Ensure compliance with payer-specific notification requirements and client contractual obligations. - Lead regular operational meetings with Guidehouse and client leadership teams. - Identify trends contributing to notification-related denials and implement corrective action plans. - Develop performance dashboards and operational reports for internal and client stakeholders. - Coordinate closely with offshore leadership to ensure alignment of workflows, quality standards, and productivity expectations. - Participate in implementation planning, workflow design, and transition activities for new client engagements. - Promote a culture of accountability, teamwork, customer service, and operational excellence. Qualifications - Bachelor’s degree in Healthcare Administration, Business Administration, or related field; or equivalent combination of education and experience. - Minimum 7 years of hands-on experience performing Notification of Admission, authorization, utilization management support, or related payer notification functions. - Demonstrated experience managing remote teams, including offshore resources. - Strong understanding of hospital inpatient and observation workflows. - Knowledge of commercial, Medicare, Medicaid, and managed care payer notification requirements. - Experience working with hospital electronic medical record systems, including Epic and/or Meditech. - Experience developing operational workflows, SOPs, and training programs. - Strong analytical, organizational, and problem-solving skills. - Excellent communication, presentation, and stakeholder management abilities. - Proficiency in Microsoft Excel, Outlook, PowerPoint, Teams, and reporting tools. Requirements - Five or more years of healthcare revenue cycle leadership experience. - Experience managing outsourced or managed services healthcare operations. - Experience supporting multiple hospital clients simultaneously. - Knowledge of authorization, utilization management, denial prevention, and case management workflows. - Experience with performance improvement methodologies and operational excellence initiatives. - Prior experience working in a consulting or healthcare managed services environment. Benefits - Medical, Rx, Dental & Vision Insurance - Personal and Family Sick Time & Company Paid Holidays - Position may be eligible for a discretionary variable incentive bonus - Parental Leave - 401(k) Retirement Plan - Basic Life & Supplemental Life - Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts - Short-Term & Long-Term Disability - Tuition Reimbursement, Personal Development & Learning Opportunities - Skills Development & Certifications - Employee Referral Program - Corporate Sponsored Events & Community Outreach - Emergency Back-Up Childcare Program

• Supervise, mentor, and develop a team of Clinical Appeals and Denials RNs. • Conduct regular coaching sessions, performance reviews, and professional development planning. • Monitor productivity, quality, and compliance metrics to ensure achievement of departmental goals. • Facilitate team meetings, training sessions, and ongoing education initiatives. • Manage staffing assignments, workload balancing, PTO coverage, and scheduling needs. • Oversee the review and management of medical necessity, authorization, and clinical validation denials. • Ensure timely preparation and submission of first-level, second-level, and external appeals. • Guide staff in developing evidence-based appeal arguments utilizing clinical documentation, regulatory requirements, and nationally recognized guidelines such as InterQual and MCG. • Review complex and high-dollar denials and provide escalation support as needed. • Ensure all appeals meet payer-specific requirements and submission deadlines. • Analyze denial trends and identify root causes impacting reimbursement. • Collaborate with Revenue Cycle, Case Management, Utilization Review, CDI, HIM, and Operational Leadership to implement denial prevention strategies. • Monitor recoveries, overturn rates, appeal success metrics, and financial outcomes. • Develop action plans to address payer performance concerns and recurring denial patterns. • Participate in client and leadership meetings to present denials performance and recommendations. • Ensure adherence to organizational policies, regulatory requirements, and payer guidelines. • Perform quality audits of appeal submissions and provide feedback to staff. • Maintain expertise in CMS regulations, Medicare and Medicaid requirements, commercial payer policies, and industry best practices. • Support audit readiness and compliance initiatives. • Identify and implement process improvements that enhance efficiency, quality, and financial outcomes. • Assist in developing standard operating procedures, workflows, and training materials. • Utilize data analytics and reporting tools to monitor team effectiveness and operational performance. • Support implementation of new clients, programs, and denial management initiatives.