Director, Medicaid Healthcare Services Solutions

This position is Flexible and the individual may reside in any KP authorized state including California, Oregon, Colorado, Washington, Hawaii, Georgia, Maryland and Washington DC.** PLEASE NOTE: Salary ranges are geographically based and the posted range reflects the Northen CA region. Lower salary ranges will apply for other labor markets outside of NCAL

Director of Medicaid Health Care Services Solutions plays a critical role in the Medicaid Line of Business to ensure all Medicaid programs meet state regulatory requirements and align with National Medicaid Care Model.

This position reports to the Sr. Director of Medicaid Solutions and focuses on developing and managing the execution of the solution roadmap for Health Care Services related solutions in partnership with our IT, informatics and data analytic partners. Solutions focus on functional areas such as Care Coordination / Care Management, Utilization Management, Population Health Management, and Quality.

This role will interface with Market operational and Permanente Medicaid Group partners to focus on Medicaid specific benefits and programs. The objective is to maximize regulatory compliance while improving member care experience and operational performance.

Oversees and directs a team of consultants to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive successful initiatives and projects within clinical settings across one or more technical areas or workstreams. Oversees and drives the development and implementation of complex clinical initiatives, systems, and processes to a desired future state. Drives the development of clinical or care delivery strategy and ensures organizational alignment and prioritization of clinical initiatives by developing and determining goals and priorities with management team sponsors; defining, developing, and evaluating performance metrics. Oversees the management of complex, highly visible projects or project components, oversees large and complex change management activities, and directs team members in performing complex data analyses to drive care delivery or clinical initiatives. Oversees vendor management as required. Monitors and takes accountability for compliance of team work activities by ensuring business plans and team members adhere to relevant policies and procedures.

• Prepares individuals for growth opportunities and advancement; builds internal collaborative networks for self and others. Solicits and acts on performance feedback; drives collaboration to set goals and provide open feedback and coaching to foster performance improvement. Demonstrates continuous learning; oversees the recruitment, selection, and development of talent; ensures performance management guidelines and expectations to achieve business needs. Stays up to date with organizational best practices, processes, benchmarks, and industry trends; shares best practices within and across teams. Motivates and empowers teams; maintains a highly skilled and engaged workforce by aligning resource plans with business objectives. Provides guidance when difficult decisions need to be made; creates opportunities for expanded scope of decision making and impact.
• Oversees the operation of multiple units within a department by identifying member and operational needs; ensures the management of work assignment completion; translates business strategy into actionable business requirements; ensures products and / or services meet member requirements and expectations while aligning with organizational strategies. Gains cross-functional support for business plans and priorities; assumes responsibility for decision making; sets standards, measures progress, and fosters resolution of escalated issues. Communicates goals and objectives; analyzes resources, costs, and forecasts and incorporates them into business plans; prioritizes and distributes resources. Removes obstacles that impact performance; guides performance and develops contingency plans accordingly; ensures teams accomplish business objectives.
• Oversees and directs a team of consultants to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive successful initiatives and projects within care delivery or clinical settings across one or more technical areas or workstreams by providing leadership to high visibility projects to identify and resolve issues of strategic importance to the organization; ensuring representation and inclusion of appropriate stakeholders and team members; building rapport and partnerships with stakeholder teams, third party vendors, and senior/executive management to produce results that are outcome driven; partnering with lead stakeholders to set the strategic direction of initiatives, develop goals and set the prioritization of deliverables; driving key processes (e.g. quality management, project change management, communication) and facilitating decisions necessary for the delivery of initiatives; communicating and resolving tough issues with stakeholders while maintaining an independent perspective; providing expertise and recommendations; and making formal presentations and providing reports to executive level audiences.
• Oversees a team of consultants in the development of requirements, for complex clinical, process, or system solutions across technical area(s) by guiding stakeholders and cross-functional teams as appropriate; providing guidance in the use multiple requirements gathering methodologies to identify clinical, functional, and non-functional requirements to meet current and future business needs; establishing the standards for the development and documentation of comprehensive case studies to assess the costs, benefits, and ROI of proposed solutions; collaborating in the development of results-driven action plans; and empowering team members in the development process as appropriate.
• Oversees and drives the development and implementation of complex clinical initiatives, systems, and processes to a desired future state by maintaining a expert understanding of how current processes impact clinical operations across multiple technical areas; identifying the operational impact of requirements on upstream and downstream solution components; providing options and recommendations to executive management and clinical stakeholders on how to integrate solutions and deliverables with current systems and processes across regions or technical areas; and monitoring the identification and validation of value gaps and opportunities for process enhancements or efficiencies.
• Drives the development of clinical or care delivery strategy and ensures organizational alignment and prioritization of clinical initiatives by developing and determining goals and priorities with management team sponsors; defining, developing, and evaluating performance metrics, standards, and methods to establish 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 overseeing a portfolio of diverse and complex initiatives to ensure delivery of measurable results and alignment with strategic objectives.
• Serves as a lead advocate of 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 clinical consulting practices, standards, and methods across KP; serving as an advocate to ensure continuous learning and improvement is championed as a people strategy; and providing ongoing coaching to build a continuous improvement mindset and build capabilities that drive results.
• Oversees the management of complex, highly visible projects or project components by coordinating and partnering with clinical leadership and key stakeholders; providing guidance on assembling teams based on project needs and team member strengths; directing the development, analysis, and management of project plans, including proposed project structure, approach and work plan; negotiating time commitments and resource forecasts across KP; managing project financials and deliverables; proactively monitoring and identifying project or clinical initiative risks, issues, and trigger events; developing mitigation plans and strategies; resolving or escalating risks or issues as appropriate; and providing leadership to project teams, as well as overseeing the work of outside consultants when needed.
• Oversees large and complex change management activities associated with care delivery or clinical initiatives by engaging and influencing stakeholders to obtain support and buy in for changes; partnering with executive management, project champions, and clinical owners to communicate and align improvement initiatives with strategic objectives; deploying appropriate change management method and approach to ensure future organizational growth and capability; and ensuring stakeholders embrace a change management mindset, understand intent and purpose, and foster a culture of change.
• Directs team members in performing complex data analyses to drive care delivery or clinical initiatives by guiding team members to employ appropriate data analysis tools and approach to assess performance; empowering team members to utilize 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; and forecasting and alleviating risks through data-driven analysis.
• Oversees vendor management as required by setting the standards for vendor performance levels; ensuring service level agreements are met; overseeing the management of vendor invoices; and partnering with Procurement, Legal and/or clinical leadership to develop service level and/or scope of work agreements as appropriate.
• Monitors and takes accountability for the compliance of team work activities by ensuring business plans and team members adhere to KP, departmental, and/or clinical policies and procedures.