Medicaid Care Model Design Consultant (Oakland)

Medicaid Care Model Design Consultant

The Medicaid Care Model Design Consultant reports directly to the Executive Director, Medicaid Care Model Strategy & Performance Management. This person will be leading the design and execution of work streams or initiatives within the Medicaid care model to improve access, quality, and cost outcomes for vulnerable populations. Collaboration with cross-functional teams, including operational and medical group partners, to gain consensus and alignment on care model strategies is critical for success. Developing robust framework and processes related to risk stratification, data and analytics, operations, care management, condition-specific strategies, and other member-facing tactics may all be part of the responsibilities of this role. The ideal candidate for the role will have experience working in Medicaid managed care, specifically related to care modeling activities.

This position can be based remote from any KP location in CA, OR, CO, WA, GA, MD, VA, HI or D.C. Only. PLEASE NOTE : Salary ranges are geographically based, and the posted range reflects the Northern CA region. Lower salary ranges will apply for other labor markets outside of NCAL.

Job Summary :

Serves as an expert consultant to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive the implementation of successful business initiatives and projects. Provides expertise and drives the development and implementation of complex business initiatives, systems, and / or processes to a desired future state. Develops business strategy and ensures alignment and prioritization of organizational objectives and business initiatives. Manages complex projects or project components, leads large and complex change management initiatives, and leads team members in performing complex data analyses to drive business initiatives. Participates in 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 communicating information and providing advice to drive projects forward; builds collaborative, cross-functional relationships.
• Drives the execution of multiple work streams by identifying member and operational needs; translates business strategy into actionable business requirements; develops and updates new procedures and policies.
• Serves as an expert consultant to ensure the alignment, buy-in, and coordination of diverse stakeholders and business owners to drive the implementation of successful business initiatives and projects across multiple functional tracks or complex workstreams by identifying and ensuring representation and inclusion of appropriate stakeholders; building rapport and partnerships with key stakeholder teams, third party vendors, and senior management; partnering with stakeholders to develop goals and set the prioritization of deliverables; driving business processes (e.g. project change management, communication) and facilitating decisions necessary for the delivery of business initiatives; communicating and resolving tough issues with stakeholders while maintaining an independent perspective; and making formal presentations and providing reports to executive level audiences.
• Develops requirements, or leads a team of consultants in the development of requirements, for complex or specialized business, process, or system solutions which may span multiple business domain(s) by leveraging partnerships with key stakeholders and cross-functional teams as appropriate; leveraging multiple business requirements gathering methodologies to identify business, functional, and non-functional requirements; and leading and overseeing the development and documentation of comprehensive business cases to assess the costs, benefits, and ROI of proposed solutions.
• Provides expertise and drives the development and implementation of complex 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 executive management and business stakeholders on how to integrate solutions and deliverables with current systems and processes across regions or domains; and leading the identification and validation of value gaps and opportunities for process enhancements or efficiencies.
• Develops business strategy and ensures alignment and prioritization of organizational objectives and business initiatives by defining, developing, and evaluating performance metrics, standards, and methods to establish business success; partnering with executive stakeholders, often with competing / conflicting objectives, to ensure cohesive and reachable metrics; refining strategic plans and performance metrics as appropriate; and managing a portfolio of diverse and complex initiatives to ensure delivery of measurable results and alignment with strategic objectives.
• Serves as a lead advocate for continuous learning and professional development by keeping abreast of cutting edge industry practices, standards, and benchmarks; attending and presenting at roadshows, conferences, and speaking events; leading 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 identifying and coordinating stakeholder contacts; assembling team based on project needs and team member strengths; developing, analyzing, and managing project plans; negotiating and managing project schedules and resource forecasts; managing project financials and deliverables; 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.
• Leads large and complex change management initiatives associated with business improvement by engaging stakeholders to obtain support and buy in for changes; partnering with executive management, project champions, and process owners to communicate and align improvement initiatives with business objectives; determining appropriate change management method and approach; and ensuring stakeholders embrace a change management mindset, understand intent and purpose, and foster a culture of change.
• Leads and consults team members in performing complex data analyses to drive business initiatives by recommending 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 advanced analyses and performing experimental tests to evaluate the effectiveness of business solutions; and identifying and alleviating risks through data-driven analysis.
• Participates in vendor management as required by reviewing 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 :

Additional Requirements :

Preferred Qualifications :