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Kaiser Permanente

Integrated healthcare provider and payer platform

Consultant 4 - External Case Management, Compliance and Risk Management

Regulatory Compliance & EthicsConfirmed live in the last 24 hours
Full-timeDenver, CO, USANo salary listedIn-person

About the Job

Requirements

  • A Bachelor's degree from an accredited college or university and at least five years of experience in consulting, project management, data analytics, operations, or a directly related field; or a Master's degree in Business, Public Health, or a directly related field and at least three years of such experience; or at least eight years of such experience.
  • Knowledge of business acumen, change management, negotiation, creativity, applied data analysis, financial acumen, conflict resolution, managing diverse relationships, process validation, project management, risk assessment, service focus, and requirements elicitation and analysis.

Responsibilities

  • Promote learning by providing or developing information, resources, advice, and expertise; build relationships with cross-functional and external stakeholders and customers; seek and address performance feedback; provide actionable feedback; pursue self-development; influence others with technical explanations, examples, options, and recommendations; adapt to change and new responsibilities; champion change; and facilitate team collaboration.
  • Complete assignments autonomously and support business-specific projects by applying subject-matter and business expertise; encourage adherence to procedures and policies; collaborate to make effective business decisions; recommend solutions to complex problems; escalate high-priority issues and risks; monitor progress and results; support work plans and resource identification; and identify improvement opportunities and engage stakeholders in solutions.
  • Consult with stakeholders to align and coordinate initiatives across workstreams; identify appropriate stakeholder representation; build partnerships with stakeholder teams, third-party vendors, and senior management; develop goals and prioritize deliverables; facilitate decisions and business processes needed to deliver initiatives; communicate difficult issues while maintaining an independent perspective; and present to and report to senior audiences.
  • Develop requirements for complex business, process, or system solutions by interfacing with stakeholders and cross-functional teams; use requirements-gathering methodologies to identify business, functional, and non-functional requirements; develop and document business cases evaluating costs, benefits, and return on investment; and lead team members in the development process as appropriate.
  • Support development and implementation of initiatives, systems, and processes by assessing current processes across domains; mapping current and future states; identifying operational impacts on upstream and downstream solutions; recommending integration with current systems and processes across regions or domains; and identifying and validating value gaps and process-efficiency opportunities.
  • Contribute to business strategy and organizational alignment by defining and evaluating performance metrics, standards, and methods; collaborating with stakeholders with competing objectives to establish cohesive and achievable metrics; refining strategic plans and metrics; and managing assigned initiatives or portfolios to deliver measurable results aligned with strategic objectives.
  • Keep abreast of industry practices, standards, and benchmarks; participate in roadshows, conferences, and speaking events; improve consulting practices, standards, and methods; advocate for continuous learning and improvement; provide training and guidance to stakeholders; and coach others to build continuous-improvement capabilities.
  • Manage complex projects or project components by coordinating stakeholder contacts; recommending or assigning resources based on project needs and team-member strengths; developing, analyzing, and managing project plans; coordinating schedules and resource forecasts; monitoring and identifying risks, issues, and trigger events; developing mitigation strategies; and resolving or escalating issues.
  • Participate in and potentially lead change-management activities by engaging stakeholders for support and buy-in; partner with management, project champions, and business owners to align communications and improvements with business objectives; identify appropriate change-management methods; and help stakeholders understand and adopt changes.
  • Perform data analyses to support business initiatives by selecting analysis tools and approaches; determining data-gathering and analysis methods; defining data requirements and obtaining customer agreement; conducting analyses and experimental tests to evaluate business solutions; and identifying and mitigating risks through data-driven analysis.
  • Support vendor management by reviewing vendor performance, ensuring service-level agreements are met, managing vendor invoices, and partnering with Procurement or Legal to develop service-level or scope-of-work agreements.
  • Monitor compliance by ensuring business plans and team members adhere to organizational, departmental, and business-line policies and procedures.
  • Lead collection, standardization, and development of policies, procedures, training, and regulatory resources for the External Care Management Compliance and Risk Management program.
  • Coordinate regulatory filings, implementation milestones, audits, and accreditation activities; oversee delegated vendors and external care management entities; and manage risk assessments, corrective action plans, and executive reporting.
  • Monitor emerging federal and state requirements, including Mental Health Parity and nonquantitative treatment limitation obligations, to promote regulatory alignment, operational readiness, and timely issue resolution.

Desired Qualifications

  • At least three years of experience consulting in a large multi-hospital system.
  • At least three years of experience working with outpatient or ambulatory service-line optimization.

About the Company

Kaiser Permanente

Integrated healthcare provider and payer platform

Kaiser Permanente runs an integrated healthcare platform that lets members manage and pay medical, premium, and pharmacy bills online. It serves Medicare Advantage, Individual and Family, and non-employer plans, offering options to pay as a guest or set up payment plans. The platform works by presenting a centralized online portal where users can view bills, choose how to pay, and handle multiple types of charges in one place. Revenue comes from premiums and medical services fees, while the service aims to reduce administrative work for both providers and patients and encourage on-time payments. What sets Kaiser Permanente apart is its combination of healthcare services with a single billing experience across multiple plan types, focusing on a user-friendly, centralized payment process rather than handling billing through separate systems. Its goal is to provide a straightforward, reliable way for members to manage and pay their bills, improving convenience and payment timeliness.

Company size
10,001+
Company stage
Grant
Total funding
$7.5M
Headquarters
Oakland, CA
Founded
1945

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