14 days old

Consultant, Executive - Quality ARL

Kaiser Permanente
Rockville, MD 20852
The AR&L Executive Consultant is responsible for providing an advanced level of consulting leadership and support to the KPMAS Region by managing and maintaining Health Plan accreditation and internal/external. The Executive Consultant plays a key role in collaborating, interacting and partnering with Subject Matter Experts (SME's), Regional Leadership, Program Office Consultants and other Regions to identify strategies and best practices for managing and ensuring accreditation, regulatory and licensure compliance.

Essential Responsibilities:
  • Plans, implements and monitors readiness activities involved in NCQA, COMAR, MCHIP, Quality Health Plan/ QIS Marketplace state and other regulatory surveys as needed (e.g. AAAHC and HPQO/Program Office). Plays key role in assessing organizational systems and processes to ensure survey readiness and determine gaps for remediation prior to regulatory surveys. ¬†Readiness activities includes reviewing, analyzing, and reporting findings internally to the Director, Senior Leadership, and to quality committees. Interfaces regularly with senior management to produce timely and valuable results.
  • Provides leadership, direct support and consultation on corrective actions for areas of non-compliance to ensure the issue(s) is adequately addressed. Fosters comprehensive standard/regulatory management and interpretation. NCQA standard interpretation requires a high degree of interpretation and analyses at times with inconclusive data/information. Executive Consultant identifies critical risks, mitigating controls and/or process improvement opportunities.
  • Develops and completes organizational annual requirements, which include but are not limited to:
  • Trilogy Documents for all lines of business: Quality Program Descriptions, Work Plans, and Work Plan Evaluations.
  • Review member communications and materials (including descriptions for quality, utilization management, benefits, member rights and responsibilities, privacy, etc.,).
  • Review practitioner/provider communication materials (QI program, UM criteria, drug
  • formulary policies, etc.,)
  • Conceptualizes and develops effective project plans, timelines, methodologies, and approaches. Manages projects and resources involved in survey preparedness or compliance/regulatory audits across multiple departments. Develops project success metrics. Continuously monitors progress and takes corrective actions that ensure successful achievement of project goals meeting expected timeline and budget.
  • Leads and manages cross functional and multi-disciplinary improvement projects. Manages, creates and maintains relationships across the organization. Recognizes, and works effectively, in complex, and ambiguous situations. Provides consulting support to, and acts as, a thought partner with other SME's and organizational leaders as required.
  • Maintains cohesion, focus, and productivity among diverse project team members. Helps team members think outside the box. Identifies, evaluates and provides verbal and written suggestions for policies, procedures and guidelines. Develops team members and other employees throughout the organization on business process redesign, project management, and problem-solving skills.
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    Posted: 2019-10-02 Expires: 2019-11-01

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    Consultant, Executive - Quality ARL

    Kaiser Permanente
    Rockville, MD 20852

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