Description:

Note: Work location is on-site with flexibility and the primary location will be in-office for meetings. Residence required in the primary location state. 393 E. Walnut St., Pasadena, California 91188

As of January 1, 2024, Kaiser Foundation Health Plan, Inc. contracts directly with the DHCS under a new direct contract to provide Medi-Cal services to enrollees in 32 counties in California. We are seeking a Medicaid Provider Network Regulatory Consultant to join our team. The successful candidate will be responsible for evaluating and implementing regulatory All Plan Letter (APL) changes from the Department of Health Care Services (DHCS) and addressing requests from the Department of Managed Health Care (DMHC). This role involves ensuring compliance with state and federal regulations, analyzing policy updates, and coordinating with internal teams to integrate new requirements into our provider network operations. Strong knowledge of Medicaid regulations, excellent analytical skills, and effective communication abilities are essential for this position.

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 a 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:


Bachelors 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 Masters 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.