Consultant IV - Medicaid Health Plan Compliance Program Manager Market

Position: Consultant IV - Medicaid Health Plan Compliance Program Manager - Hawaii Market
Description:

This Consultant IV role is responsible for Medicaid Health Plan Compliance (MHPC) compliance program management as required under Kaiser Permanente's Medicaid Direct Contract (QUEST Integration) with the State of Hawaii Department of Human Services (DHS). In partnership with MHPC leadership and Ethics and Compliance partners, the Compliance Program Manager identifies and investigates unusual incidents, and provides Compliance guidance to operational stakeholders to inform the development and implementation of corrective action plans that aid in the Health Plan's prevention and detection of potential Fraud Waste and Abuse (FWA) activities.

The Compliance Program Manager is responsible for providing Compliance guidance to inform development and implementation of policies, procedures, and practices to ensure compliance with all requirements of the QUEST Integration Contract. The Compliance Program Manager serves as the designated Medicaid Health Plan Compliance (MHPC) market Subject Matter Expert (SME) with primary responsibility for providing Compliance oversight to ensure adherence to policies and establish and maintain effective lines of communication between MHPC leadership and Health Plan staff, and between MHPC and DHS staff, as appropriate.

Job Summary:

Serves as a consultant 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. Contributes to business strategy and supports organizational alignment and prioritization of business initiatives. Manages complex projects or project components, participates in and may lead 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:

Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations.

Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.

Completes work assignments autonomously and supports business-specific projects by applying expertise in subject area and business knowledge to generate creative solutions; encourages team members to adapt to and follow all procedures and policies. Collaborates cross-functionally and/or externally to achieve effective business decisions; provides recommendations and solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Supports the development of work plans to meet business priorities and deadlines;

identifies resources to accomplish priorities and deadlines. Identifies, speaks up, and capitalizes on improvement opportunities across teams; uses influence to guide others and engages stakeholders to achieve appropriate solutions.

Serves as a consultant to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive the implementation of successful business initiatives and projects across one or more functional tracks or work streams 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;

discussing involvement of business processes (e.g. project change management, communication) and facilitating decisions necessary for the delivery of business initiatives; communicating tough issues to stakeholders while maintaining an independent perspective; and making formal presentations and providing reports to various senior level audiences.

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