JOB SUMMARY:

In addition to the responsibilities listed below, this position is also responsible for planning, developing, and implementing provider satisfaction strategies to improve network relationships and enhance provider engagement; developing provider relations programs to facilitate effective provider communications and problem resolution; and creating and distributing media materials (e.g., articles and newsletters), publications, and manual updates to providers; ensuring providers adhere to regulatory and contractual requirements; escalating complex compliance issues to appropriate parties; supporting organizational responses to regulatory audits; and delivering provider education and/or onboarding.

MINIMUM QUALIFICATIONS:

• Minimum one (1) year of experience in a leadership role with or without direct reports.
• High School Diploma or GED AND minimum seven (7) years of experience in health care delivery or operations in a managed care environment, customer relationship management, or a directly related field.

ADDITIONAL REQUIREMENTS:

• Knowledge, Skills, and Abilities (KSAs): Internal or External Publication; Provider Data Systems/Processes; Business Process Improvement; Written Communication; Compliance Management; Applied Data Analysis; Trend Analysis; Knowledge Management; Business Relationship Management; Consulting; Interpersonal Skills; Key Performance Indicators; Time Management; Quality Assurance Process; Computer Literacy; Presentation Skills; Health Care Reimbursement; Training; Business Acumen; Business Planning; Project Management
  PrimaryLocation : California,Pasadena,Walnut Center - Regional Offices
  HoursPerWeek : 40
  Shift : Day
  Workdays : Mon, Tue, Wed, Thu, Fri
  WorkingHoursStart : 09:00 AM
  WorkingHoursEnd : 06:00 PM
  Job Schedule : Full-time
  Job Type : Standard
  Employee Status : Regular
  Employee Group/Union Affiliation : NUE-SCAL-01|NUE|Non Union Employee
  Job Level : Individual Contributor
  Job Category : Health Care Operations,Health Care & Hospital Operations
  Department : Regional Offices - Pasadena - Cost/Bene-Cost Mgmt Svcs-Hub - 0808
  Travel : No
  Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.

For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:

• Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente’s Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licensure requirements (where applicable), and Kaiser Permanente’s policies and procedures.
• Models and reinforces ethical behavior in self and others in accordance with the Principles of Responsibility, adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty, shows consistency in words and actions; follows through on commitments.
• Job duties with at least occasional or possible access to: (1) patients, the general public, or other employees; (2) confidential protected health information and other confidential KP information (including employee, proprietary, financial or trade secret information); (3) KP property and assets, for example, electronic assets, medical instruments, or devices; (4) controlled substances regulated by federal law or potentially subject to diversion.

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.
• Supports continuous improvement efforts by: utilizing provider, claims, and contracting data to identify and/or consult on continuous improvement across the contract ecosystem (e.g., identifying business and operational disparities between organizational and provider expectations, constraints, and risks to accessible care, building and maintaining relationships); implementing process improvement initiatives to aid providers and business goals; participating in collaborations with internal and external partners to develop network strategies and implement improved access to care; and may also include conducting and/or collaborating on advanced modeling and analyses of provider and market data to develop recommendations, solutions, and action plans for improvement initiatives.
• Ensures contract commitments are met by: gathering, validating, maintaining, summarizing, and/or analyzing provider and contract data of the day-to-day operation and management of services to consult on provider compliance; identifying and documenting provider activities and/or coordinating with alternate stakeholders to ensure compliance with contract terms and conditions; leveraging guidelines to ensure provider compliance with state and federal regulations as well as KP policies and procedures; and consulting with Provider Systems Administration (PSA) or its equivalent as needed to ensure proper contract interpretation and operational readiness and supporting corrective actions as identified through contract performance.
• Supports contract strategy development by: researching, developing, and assisting in the proposal and implementation of strategies that improve access to patient care while managing outside service costs; providing advanced consultation on local service delivery planning and delivery system leadership to aid in the achievement of provider priorities and strategies; may include engaging in collaborative cross-functional workgroups to ensure provider strategies meet the unique needs of diverse stakeholders; and may also include developing materials and/or conducting peer training for new hires and contingent workers(e.g., establishing contract language, determining payment rate parameters, defining workflow and business processes, and ensuring cross-training across all service lines).
• Supports the growth of the Provider Network by: reviewing or identifying recommended/potential partners/alliances for assigned service area to fill service gaps or decrease costs in current service offerings; developing and maintaining trusted partnerships with providers to understand their unique service request needs and challenges; serving as a liaison between providers and KP by contributing to communication efforts (e.g., contract compliance such as access, availability, referral operations, and/or supporting member complaints); and supporting provider site visits, daily interactions, and ad hoc meetings by partnering with others to develop itineraries and agendas, gather credentialing materials, and/or initiate this process.
• Contributes to provider satisfaction by: leveraging in-depth knowledge of provider/contract operations to consult on issues that arise from contract configuration/interpretation and/or related to claims/disputes, billing, payment, reimbursement, other operational issues, and/or directories; ensuring requests for information, questions, and problems are identified, documented, and addressed in a timely manner; and in some instances, collaborating, creating, and/or delivering training materials to aid provider education and orientation on health plan systems, processes, and/or credentialing.

For jobs where work will be performed in unincorporated LA County, the employer provides the following statement in accordance with the Los Angeles County Fair Chance Ordinance. Criminal history may have a direct, adverse, and negative relationship on the following job duties, potentially resulting in the withdrawal of the conditional offer of employment:

• Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente’s Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state, and local laws and regulations, accreditation, and licensure requirements (where applicable), and Kaiser Permanente’s policies and procedures.
• Models and reinforces ethical behavior in self and others in accordance with the Principles of Responsibility, adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty, shows consistency in words and actions; follows through on commitments.
• Job duties with at least occasional or possible access to: (1) patients, the general public, or other employees; (2) confidential protected health information and other confidential KP information (including employee, proprietary, financial or trade secret information); (3) KP property and assets, for example, electronic assets, medical instruments, or devices; (4) controlled substances regulated by federal law or potentially subject to diversion