Consultant IV, Medicaid Regulatory Support/Consulting

Kaiser Permanente

$124K — $161K *

clock More than 8w ago

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5 - 7 years of experience

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Job Description

Description:
The Medicaid Consultant will interpret and apply DHCS (Department of Health Care Services) Standards, DMHC (Department of Managed Healthcare) Standards, Contract Standards, and CMS Standards to healthcare operations and Health Plan business functions.

They will develop project plans and manage project teams to ensure DHCS Standards, DMHC Standards, Contract Standards, and CMS Standards are implemented in Health Plan and delivery system operations. Build required program, policy, procedure, and workflow documentation needed to demonstrate compliance with regulatory standards. Communicate programmatic and operational requirements to all levels of personnel throughout the organization. Develop training materials and train personnel on DHCS Standards, DMHC Standards, Contract Standards, CMS Standards, and operational Medicaid program decisions.

Job Summary:

Serves as a consultant to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive the implementation of successful business initiatives and projects. Provides insight and supports the development and implementation of business initiatives, systems, and/or processes to a desired future state. Contributes to business strategy and supports organizational alignment and prioritization of business initiatives. Manages complex projects or project components, participates in and may lead change management activities, and performs data analyses in support of business initiatives. Supports vendor management as required. Monitors compliance of work activities by ensuring business plans and team members adhere to relevant policies and procedures.

Essential Responsibilities:

  • Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers.
  • Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations.
  • Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.
  • Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results.
  • Supports the development of work plans to meet business priorities and deadlines; identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.
  • Serves as a consultant to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive the implementation of successful business initiatives and projects across one or more functional tracks or workstreams by identifying and ensuring representation and inclusion of appropriate stakeholders; building rapport and partnerships with stakeholder teams, third party vendors, and senior management; working with stakeholders to develop goals and set the prioritization of deliverables; discussing involvement of business processes (e.g. project change management, communication) and facilitating decisions necessary for the delivery of business initiatives; communicating tough issues to stakeholders while maintaining an independent perspective; and making formal presentations and providing reports to various senior level audiences.
  • Develops requirements for complex business, process, or system solutions within assigned business domain(s) by interfacing stakeholders and cross-functional teams as appropriate; leveraging multiple business requirements gathering methodologies to identify business, functional, and non-functional requirements; developing and documenting comprehensive business cases to assess the costs, benefits, and ROI of proposed solutions; and leading team members in the development process as appropriate.
  • Provides insight and supports the development and implementation of business initiatives, systems, and/or processes to a desired future state by maintaining a comprehensive understanding of how current processes impact business operations across multiple domains; mapping current state against future state processes; identifying the operational impact of requirements on upstream and downstream solution components; providing options and recommendations to management and business stakeholders on how to integrate solutions and deliverables with current systems and business processes across regions or domains; and identifying and validating value gaps and opportunities for process enhancements or efficiencies.
  • Contributes to business strategy and supports organizational alignment and prioritization of business initiatives by defining, developing, and evaluating performance metrics, standards, and methods to establish business success; collaborating with multiple stakeholders, often with competing/conflicting objectives, to ensure cohesive and reachable metrics; refining strategic plans and performance metrics as appropriate; and managing assigned initiatives or portfolio to ensure delivery of measurable results and alignment with strategic objectives.
  • Serves as an advocate of continuous learning and professional development by keeping abreast of industry practices, standards, and benchmarks; attending and participating in roadshows, conferences, and speaking events; contributing to the ongoing enhancement and innovation of consulting practices, standards, and methods across KP; serving as an advocate to ensure continuous learning and improvement is championed as a people strategy; providing training and guidance to stakeholders as appropriate; and providing ongoing coaching to build a continuous improvement mindset and build capabilities that drive results.
  • Manages complex projects or project components by coordinating stakeholder contacts; recommending or assigning team resources based on project needs and team member strengths; consulting in the development, analysis, and management of project plans; coordinating project schedules and resource forecasts; proactively monitoring and identifying project or business initiative risks, issues, and trigger events; developing mitigation plans and strategies; and resolving or escalating risks or issues as appropriate.
  • Participates in and may lead change management activities associated with business initiatives by engaging stakeholders to obtain support and buy in for changes; partnering with management, project champions, and business owners to communicate and align improvement initiatives with business objectives; identifying appropriate change management method and approach; and ensuring stakeholders embrace a change management mindset, understand intent and purpose, and foster a culture of change.
  • Performs data analyses to support business initiatives by identifying appropriate data analysis tools and approach to assess business performance; determining suitable data gathering and analysis methods (e.g., process observation, hard data, etc.); defining data requirements and obtaining customer agreements, including customer requirements as appropriate; conducting analyses and performing experimental tests to evaluate the effectiveness of business solutions; and identifying and alleviating risks through data-driven analysis.
  • Supports vendor management as required by assisting with reviews of vendor performance levels; ensuring service level agreements are met; managing vendor invoices; and partnering with Procurement and/or Legal to develop service level and/or scope of work agreements as appropriate.
  • Monitors compliance of work activities by ensuring business plans and team members adhere to KP, departmental, and/or business line policies and procedures.

Minimum Qualifications:

  • Bachelor's degree from an accredited college or university and Minimum five (5) years' experience in consulting, project management, data analytics, operations or a directly related field OR Master's degree in Business, Public Health, or a directly related field and Minimum three (3) years' experience in consulting, project management, data analytics, operations or a directly related field OR Minimum eight (8) years' experience in consulting, project management, data analytics, operations or a directly related field.

Additional Requirements:

  • Knowledge, Skills, and Abilities (KSAs): Business Acumen; Change Management; Negotiation; Creativity; Applied Data Analysis; Financial Acumen; Conflict Resolution; Managing Diverse Relationships; Process Validation; Project Management; Risk Assessment; Service Focus; Requirements Elicitation & Analysis.

Preferred Qualifications:
  • Two (2) years' experience working with data analysis software (e.g., Minitab, QI Macros, Tableau, etc.).
  • Two (2) years' experience developing and delivering executive communications.
  • A successful candidate will have at a minimum 1-2 years of Medicaid/Medi-Cal experience, along with skills in performance improvement and Program Management experience.
  • Excellent authorship and writing skills.
  • Strong critical thinking and analysis skills.
  • Project management/organizational skills - ability to develop action plans.
  • Strong interpersonal communication skills.
  • Strong computer software skills - Microsoft Word, Microsoft Excel, Email Applications.
  • Must be able to work/collaborate with a diverse team of clinical and nonclinical individuals.
  • Some compliance or legal experience preferred.
  • Master(s) or relevant certification(s) preferred.
  • Pays attention to detail.
  • Takes accountability for work.

Primary Location: California,Oakland,1800 Harrison Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 08:00 AM Working Hours End: 05:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: NUE-PO-01|NUE|Non Union Employee Job Level: Individual Contributor Specialty: Consulting Department: Oakland Reg - 1800 Harrison - Medicaid - 0308 Pay Range: $124400 - $161040 / year The ranges posted above reflect the location in the job posting. The salary range may vary if you reside in a different location or state than the location posted. Travel: Yes, 10 % of the Time At Kaiser Permanente, equity, inclusion and diversity are inextricably linked to our mission, and we aim to make it a part of everything we do. We know that having a diverse and inclusive workforce makes Kaiser Permanente a better place to receive health care, a more supportive partner in our communities we serve, and a more fulfilling place to work. Working at Kaiser Permanente means that you agree to and abide by our commitment to equity and our expectation that we all work together to create an inclusive work environment focused on a sense of belonging and wellbeing.

Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status. Submit Interest
Kaiser Permanente is a healthcare organization that provides health insurance and medical care to members in several states across the United States. The organization was founded in 1945 and is headquartered in Oakland, California. Kaiser Permanente operates hospitals, medical centers, and clinics, and offers a range of services including primary care, specialty care, and emergency care. The organization is known for its integrated healthcare model, which combines health insurance and medical care in a single system. Kaiser Permanente is also committed to promoting health equity and addressing social determinants of health, such as housing and food insecurity.
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