Executive Director, Provider Data MgmtLocation: Burbank, CA Job Number: 970406 Date posted: 06/10/2021
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This role is responsible for managing a National Provider Data Management business and IT solution focused on creating a Health Plan System of Reference for provider demographic data used for business and regulatory reporting. The role manages the strategic direction, implementation management, governance, financial management and funding and data stewardship. This individual will implement and manage an ongoing Shared Service supporting Regional and program provider demographic data needs.
- In conjunction with KPIT and program leadership, manages the direction and strategy for the Health Plan Provider Data Management Program (HPPDM) focused on becoming the Heath Plan source of data, reporting and information related to all networks, across all Regions and LOBs, including internal and external provider data.
- Implements the Shared Service for management of provider data. Includes directing enterprise wide processes for collection, management and dissemination of provider demographic data as well as directing the Shared Services offerings, building the staffing model, developing and agreeing to SLAs with the regions, managing against the SLAs, increasing and expanding production capabilities, moving production of reports such as network adequacy to the HPPDM platform.
- Develops and manages the HPPDM program budgets including the annual Multi Year Plan (MYP) budgets. Responsibilities include ROI forecasts, reports program status at POC meetings, promotes the projects at the annual MYP Regional roadshows, requests all funding releases at PMC and POC meetings, coordinates with Health Plan IT Finance and NCA finance on budgets. Responsible for management of the $25 M life of project budgets.
- Establishes and manages National and Regional HPPDM governance structures including setting agendas, achieving agreement on direction, reporting program status and establishment and reporting on SLAs.
- Serves as the Health Plan Data Steward for the Provider Data domain. Works with the Chief Data Office, other functions and regions to develop data rules and standards, policies for data access and use, population of the data discovery center and dissemination of best practices related to data management.
- Coordinates and partners with internal functions including KPIT, Regulatory and Compliance, KP Legal, Regional data owners, Health Plan Data Strategy, etc. to address uses and needs of data and develop solutions.
- Responsible for directory data solutions to meet the needs of key regulatory and business requirements.
- Assumes joint accountability with markets for Internal Audit goals. Reports out to the National Health Plan Compliance Committee on program status with a focus on Directory Compliance.
- Establishes network adequacy monitoring processes and tools including CMS Medicare quarterly network adequacy monitoring program. Maintains the Quest Analytics software contract, provision and train users, upgrade software, trouble shooting and problem solving with the vendor. Reports results to Regions and leadership. Develops innovative solutions to measurement network adequacy including use of ArcGIS.
- Leads data strategy and implementation related to significant regulatory requirements including CMS Interoperability, HR 133 (No Surprises Act), and large KP projects, i.e., TriCare, Expansion projects, new product initiatives, etc. In conjunction with Senior Leadership and key stakeholders builds a solution for supporting the data reporting and directory requirements for these projects.
- Promotes the data strategy across the enterprise including introducing solutions that will utilize the shared service, i.e., supporting the Proposal Unit, Employer requests for directory data, network adequacy tools and assessments, MediCal Reporting, Renal Care group analytics, facility data management solutions.
- Monitors state, federal and accreditation regulatory requirements for directories, evaluate KP directory readiness and work with Regions and internal functions on gap remediation.
- Contracts for and manages external directory vendor agreements and directory production for Dual Choice products.
- Directs the implementation of a Data Management Community of Practice as well as an ad hoc Network Adequacy Community of Practice. These groups are used to develop policy and procedures, share best practices, disseminate information about regulatory and business requirements and processes.
- Minimum ten (10) years’ experience in the health care industry.
- Minimum (7) years management experience.
- Minimum (5) years experience in health care consulting to providers and managed care organizations.
- Bachelors degree is required.
- Experience in managing care provider contracting/ network development and hospital/health system administrations.
- Experience leading a shared service in a large organization.
- Internal or external business consulting experience.
- Ability to prepare and deliver presentations to executives.
- Masters degree in Healthcare, Business, Public Health or related field is preferred.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.
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