Consultant III, Medicaid Regulatory Support/Consulting

The Medicaid Regulatory Consultant will interpret and apply DHCS Standards, DMHC Standards, Contract Standards, and CMS Standards to healthcare operations and Health Plan business functions. 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. 

They will 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 part of a consulting team 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. Supports strategic planning and organizational alignment and prioritization of business initiatives. Manages moderately complex projects or project components, participates in 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:

·Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members.

·Listens to, seeks, and addresses performance feedback; provides mentoring to team members.

·Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples.

·Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes.

·Supports and responds to the needs of others to support a business outcome.

·Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives.

·Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. 

·Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.

·Serves as part of a consultant team to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive the implementation of successful business initiatives and projects within a functional track or workstream 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; identifying and escalating tough stakeholder issues while maintaining an independent perspective; preparing presentations and reports; and leading or facilitating team meetings.

·Develops requirements for 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; and developing and documenting comprehensive business cases to assess the costs, benefits, and ROI of proposed solutions.

·Provides insight and supports the development and implementation of business initiatives, systems, and/or processes to a desired future state by maintaining a working understanding of how current processes impact business operations; 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; and identifying and validating value gaps and opportunities for process enhancements or efficiencies.

·Supports strategic planning and 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; and managing assigned initiatives 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; and serving as an advocate to ensure continuous learning and improvement is championed as a people strategy.

·Manages moderately 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 change management activities associated with business initiatives by engaging stakeholders to obtain support and buy in for changes; collaborating with management, project champions, and business owners to communicate and align improvement initiatives with business objectives; using appropriate change management methods and approaches; and ensuring stakeholders embrace a change management mindset and understand initiative intent and purpose.

·Performs data analyses to support business initiatives by using appropriate data analysis tools and approach to assess business performance; deploying 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; and partnering with Procurement and/or Legal to assist in the development of 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.