Consultant V, Medicare Provider Contract Configuration

The National Health Plan organization aims to enhance the growth, competitive position, and performance of each KP market and KP overall by improving capabilities and responding to evolving demands. They focus on creating and delivering national capabilities at scale to support national and local efforts in acquiring, serving, and retaining KP membership. The National Provider Systems Administration (NPSA) team configures provider contracts, data, and fee schedules within the Tapestry A/P claims system to support automated and error-free claim payments. They collaborate with market and national partners to implement new contracts, amendments, and updates before effective dates. Their services include high-quality configuration outcomes, timely build processes, and cost containment to meet affordability objectives.

Serves as lead consultant to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive the implementation of successful business initiatives and projects. Provides expertise and drives the development and implementation of business initiatives, systems, and/or processes to a desired future state. Develops business strategy and ensures alignment and prioritization of organizational objectives and business initiatives. Manages complex projects or project components, leads change management activities, and performs complex data analyses to drive 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 relationships with cross-functional stakeholders. Listens, responds to, seeks, and addresses performance feedback; provides actionable feedback to others, including upward feedback to leadership and mentors junior team members. Practices self-leadership; creates and executes plans to capitalize on strengths and improve opportunity areas; influences team members within assigned team or unit. Adapts to competing demands and new responsibilities; adapts to and learns from change, challenges, and feedback. Models team collaboration within and across teams.
• Conducts or oversees business-specific projects by applying deep expertise in subject area; promotes adherence to all procedures and policies. Partners internally and externally to make effective business decisions; determines and carries out processes and methodologies; solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Develops work plans to meet business priorities and deadlines; coordinates and delegates resources to accomplish organizational goals. Recognizes and capitalizes on improvement opportunities; evaluates recommendations made; influences the completion of project tasks by others.
• Serves as a lead consultant to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive the implementation of successful business initiatives and projects 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 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 and resolving tough issues with stakeholders while maintaining an independent perspective; and making formal presentations and providing reports to executive level audiences.
• Develops requirements, or leads a team of consultants in the development of requirements, for complex or specialized business, process, or system solutions which may span multiple business domain(s) by partnering 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.
• Provides expertise and drives 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; identifying the operational 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 or domains; and identifying and validating value gaps and opportunities for process enhancements or efficiencies.
• Develops business strategy and ensures alignment and prioritization of organizational objectives and business initiatives by defining, developing, and evaluating performance metrics, standards, and methods to establish business success; partnering with senior 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.
• 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, and speaking events; 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.
• Manages complex projects or project components by coordinating stakeholder contacts; assembling team 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.
• Leads change management activities associated with business initiatives by engaging stakeholders to obtain support and buy in for changes; partnering with senior management, project champions, and process owners to communicate align improvement initiatives with business objectives; determining appropriate change management method and approach; and ensuring stakeholders embrace a change management mindset, understand intent and purpose, and foster a culture of change.
• Performs complex data analyses to drive business initiatives by 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 analyses and performing experimental tests to evaluate the effectiveness of business solutions; and identifying and alleviating risks through data-driven analysis.
• 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.