Manager, Managerial Consulting - Health Plan Shared Services

Pasadena, CA Other
POSTED ON 4/12/2024

The CA/HI Medicaid Care Delivery & Operations team aims to lead in addressing disparities in health and health care systems to ensure total health and health equity for Medicaid members and their families. The team ensures optimal care and coverage for Medicaid members in CA and HI by implementing, managing, and executing on regulatory and strategic programs across a broad scope including care coordination, local community engagement, quality, care delivery, and behavioral health.



The Manager, Consulting – Health Plan Shared Services position serves as the Implementation Team Lead for CA statewide Health Plan Shared Services functions including: claims, letters, authorizations, chart reviews, case summarizations and trending, communications (member, vendor, provider, community entity letters), training and claims support. 



Job Summary:

Manages a team of consultants 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 workstreams. Drives business strategy, organizational alignment, and prioritization of business initiatives. Manages the work of project/program team members by managing the coordination of internal and/ or external resources. Manages the development and implementation of business initiatives, systems, and/or processes to a desired future state. Manages complex, cross-functional projects/programs for teams and manages/ensures the proactive monitoring and identification client, project, program, and/or business risks. Manages change management plans associated with business initiatives. Manages team members 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.



Essential Responsibilities:


  • Provides developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works closely with employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; develops and provides training and development to talent for growth opportunities; supports execution of performance management guidelines and expectations. Leads, adapts, implements, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams. Delegates tasks and decisions as appropriate; provides appropriate support, guidance, and scope; encourages development and consideration of options in decision making.

  • Manages designated work unit or team by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed. Aligns team efforts; builds accountability for and measuring progress in achieving results; determines and ensures processes and methodologies are implemented; resolves escalated issues as appropriate; sets standards and measures progress. Fosters the development of work plans to meet business priorities and deadlines; obtains and distributes resources. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams to execute in alignment with operational objectives.

  • Manages a team of consultants 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 workstreams by identifying representation and inclusion of appropriate stakeholders; building rapport and partnerships with key stakeholder teams, third party vendors, and senior management; working with stakeholders to develop goals and set the prioritization of deliverables; developing of a menu of solutions for complex, competing, or ambiguous requests; facilitating 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; nd making formal presentations and providing reports to senior 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; developing and evaluating performance metrics, standards, and methods to establish business success; managing the development of strategic roadmaps for solution development and deployment; ering with senior cross-functional stakeholders, often with competing/conflicting objectives to ensure cohesive and reachable metrics; g strategic plans and performance metrics as appropriate; and managing complex initiatives or portfolio to ensure delivery of measurable results and alignment with strategic objectives.

  • Manages the work of project/program team members by managing the coordination of internal and/ or external resources based on the alignment of team member skills and project/program demands; managing the delivery and promotion of the strategic vision and objectives to team members; and managing the delivery of performance feedback to team members supervisors and leadership as appropriate.

  • Manages 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 partnering with stakeholders and cross-functional teams as appropriate; providing guidance in the use of multiple business requirements gathering methodologies to identify business, functional, and non-functional requirements; and monitoring the development and documentation of comprehensive business cases to assess the costs, benefits, and ROI of proposed solutions.

  • Manages 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; leveraging stakeholder partnerships to identify the operational needs and impact of requirements on upstream and downstream solution components; providing options and recommendations to senior 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 managing the establishment of appropriate governance and workgroup infrastructures to accomplish strategic outcomes.

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

  • Manages and ensures the proactive monitoring and identification of client, project, program, and/or business risks, issues, and trigger events by leading the development of mitigation plans and strategies; and resolving or escalating risks or issues as appropriate.

  • Manages change management plans associated with business initiatives by engaging stakeholders to obtain support and buy in for changes; partnering with senior management, project/program champions, and business owners to communicate and align improvement initiatives with business objectives; recommending appropriate change management methods and approaches; and ensuring stakeholders embrace a change management mindset, understand intent and purpose, and foster a culture of change.

  • Manages team members in the assessment of strategic performance metrics to support business initiatives by leveraging partnerships with data analytic teams to ensure the translation of business requirements into analytic specifications; recommending 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; and ensuring risks are identified and alleviated through data-driven analysis.

  • Advocates 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.

Qualifications:

Minimum Qualifications:


  • Minimum two (2) years experience in a leadership role with or without direct reports.

  • Bachelors degree from an accredited college or university and Minimum eight (8) 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 six (6) years experience in consulting, project management, data analytics, operations or a directly related field OR Minimum eleven (11) 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

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