Managerial Consultant VI, Medicare Risk Adjustment Strategy

Managerial Consultant VI, Medicare Risk Adjustment Strategy

The Managerial Consultant VI role reports to the VP of Retro Chart Operations in reporting and analyzing retrospective coding and retrieval programs. The incumbent will be responsible for delivering analytic insights related to KPIs and trend analyses to support reporting and early intervention. Additionally, the role includes supporting program reporting to all levels of management on program status within Medicare and particularly in insurance payers and risk adjustment/retrospective programs.

Serves as an expert consultant to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive the implementation of strategic business initiatives and projects/programs across multiple functional tracks or complex workstreams. Drives business strategy, organizational alignment, and prioritization of business initiatives. Leads the work of project/program team members by requesting and coordinating internal and/or external resources. Serves as a lead expert in the development and implementation of business initiatives, systems, and/or processes to a desired future state. Manages complex, highly visible or specialized cross-functional projects/programs, and serves as a lead expert in the proactive monitoring and identification of client, project, program, and/or business risks. Designs, leads, and serves as a lead expert for change management plans associated with business initiatives. Serves as a lead expert in the assessment of strategic performance metrics to support 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.

Promotes learning in others by communicating information and providing advice to drive projects forward; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; provides actionable feedback to others, including upward feedback to leadership; influences, mentors, and coaches team members. Practices self-leadership; creates, evaluates, and responds to the strengths and weaknesses of self and unit or team members. Leads the adaptation to competing demands and new responsibilities; adapts to and learns from change, challenges, and feedback. Fosters open dialogue amongst team members.

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. Gains cross-functional support for objectives and priorities; determines and carries out processes and methodologies; solves highly complex issues; escalates and resolves issues as appropriate; sets standards and measures progress. Develops work plans to meet business priorities and deadlines; coordinates, obtains and distributes resources. Removes obstacles that impact performance; guides performance and develops contingency plans accordingly; influences the completion of project tasks by others.

Serves as an expert consultant to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive the implementation of strategic business initiatives and projects/programs 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 executive management; partnering with stakeholders to develop goals and set the prioritization of deliverables; leading the development of a menu of solutions for complex, competing, or ambiguous requests; driving discussions regarding the involvement of business processes (e.g. 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 senior executive level audiences.

Drives business strategy, organizational alignment, and prioritization of business initiatives by working closely with senior executives to facilitate the development, refinement, and articulation of the business strategy; defining, developing, and evaluating performance metrics, standards, and methods to establish business success; leading the development of strategic roadmaps for solution development and deployment; collaborating with senior cross-functional stakeholders, often with competing/conflicting objectives to ensure cohesive and reachable metrics; refining strategic plans and performance metrics as appropriate; and managing complex initiatives or portfolio to ensure delivery of measurable results and alignment with strategic objectives.

Leads the work of project/program team members by requesting and coordinating internal and/ or external resources based on the alignment of team member skills and project/program demands; delivering and promoting strategic vision and objectives to team members; and delivering performance feedback to team members supervisors and leadership as appropriate.

Leads and provides expertise to a team of consultants in the development of requirements for large-scale, complex, or specialized business, process, or system solutions across business domain(s) by leveraging partnerships with 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.

Serves as a lead expert in 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; leveraging stakeholder partnerships to identify the operational needs and impact of requirements on upstream and downstream solution components; providing options and recommendations to senior executive management and business stakeholders on how to integrate solutions and deliverables with current systems and business processes across regions and domains; identifying and validating value gaps and opportunities for process enhancements or efficiencies; and leading the establishment of appropriate governance and workgroup infrastructures to accomplish strategic outcomes.

Manages complex, highly visible or specialized, cross-functional projects and/or programs by coordinating stakeholders; recommending or assigning team resources based on project needs and team member strengths; consulting in the development, analysis, and management of project/program plans; collaborating on the coordination of project/program scope, schedules, and resource forecasts; proactively monitoring and identifying project/program/business initiative risks, issues, and trigger events; developing mitigation plans and strategies; and resolving or escalating risks or issues as appropriate.

Serves as a lead expert in the proactive monitoring and identification of client, project, program, and/or business risks, issues, and trigger events by leading and overseeing the development of mitigation plans and strategies; and resolving or escalating risks or issues as appropriate.

Designs, leads, and serves as a lead expert for change management plans associated with business initiatives by engaging stakeholders to obtain support and buy in for changes; partnering with executive management, project/program 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.

Serves as a lead expert in the assessment of strategic performance metrics to support business initiatives by building partnerships with data analytic teams to ensure the translation of business requirements into analytic specifications; 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 advanced statistical analyses and/or testing to evaluate the effectiveness of business solutions; identifying and alleviating risks through data-driven analysis; and keeping current on, evaluating, and integrating data analytic trends and best practices to meet the demands of a continuously evolving analytic landscape.

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, training seminars, and/or speaking events as appropriate; 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.

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:

• Minimum four (4) years experience in a leadership role with or without direct reports.
• Bachelors degree from an accredited college or university and Minimum ten (10) years experience in consulting, project management, data analytics, operations or a directly related field OR Masters degree in Business Administration, Public Health, Health Services Administration, or related field and Minimum eight (8) years experience in consulting, project management, data analytics, operations or a directly related field OR Minimum thirteen (13) 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; Business Process Improvement; Creativity; Applied Data Analysis; Financial Acumen; Business Relationship Management; Conflict Resolution; Managing Diverse Relationships; Process Validation; Project Management; Risk Assessment; Service Focus; Requirements Elicitation & Analysis

Preferred Qualifications:

• Five (5) years of experience working with care transformation operations.
• Project Management Professional (PMP), Six Sigma, or Scrum Master certification.

Primary Location: Maryland, Upper Marlboro, Service West Inc. - Maryland

Additional Locations: