Director, Process Improvement, Risk Adjustment Oversight

Kaiser Permanente; Denver (CO); Remote; USD 160,000 - 260,000; Full time

Job summary

Kaiser Permanente is seeking a Director, Process Improvement, Risk Adjustment Oversight to provide strategic oversight of risk adjustment processes, data submission integrity, risk mitigation, and governance. The role leads evaluation of new and existing processes and collaborates with Legal, Compliance, and stakeholders to drive remediation through resolution.

The position directs large-scale change management activities, supports cross-functional teams, and oversees data analyses to improve

Qualifications

• Minimum three (3) years experience in a leadership role with direct reports.
• Bachelor's degree and minimum ten (10) years progressive experience in project management or related field, including five (5) years in process improvement or related field.

Responsibilities

• Prepares individuals for growth opportunities and advancement; builds internal collaborative networks and provides coaching to foster performance improvement.
• Oversees the operation of multiple units within a department; translates strategy into actionable requirements; allocates resources to meet objectives.
• Guides the use of Lean/Six Sigma and data-driven PI principles; oversees development of process architecture and results presentations to management.
• Builds trusted partnerships with stakeholders; drives continuous improvement culture and trains management in KP process improvement leadership.
• Directs strategic planning to align objectives with performance metrics and measurable outcomes; manages a portfolio of initiatives for growth.

Skills

Ambiguity management

Attention to detail

Communication

Critical thinking

Leadership

Problem solving

Strategic thinking

Team building

Teamwork

Education

Bachelor's degree

Job description

This is a flexible role and open to candidates residing in the following KP authorized states to include CA, WA, OR, CO, IL, GA, MD, DC, and VA. Please Note: Salary ranges are geographically based, and the posted range reflects the CO region. Salary ranges could be lower or higher than the one presented depending on the location.

Technical Summary:

The Director, Process Improvement, Risk Adjustment Oversight provides strategic oversight of risk adjustment processes, with a focus on data submission, data integrity, risk mitigation, and process effectiveness. This role leads the evaluation of new and existing processes, identifies and tracks critical risk adjustment issues, and partners with Legal, Compliance, and business stakeholders to drive remediation through resolution. The Director supports cross-functional teams in addressing high-risk issues and strengthening end-to-end processes, documentation, and controls. Key responsibilities also include supporting risk and control assessments and SOX reviews to promote effective governance, accountability, and ongoing process improvement.

Job Summary:

Directs the delivery, execution, and sustainment of process improvement (PI) engagements including kaizen. Ensures consultation is provided to stakeholders and process owners by building and nurturing trusted partnerships between stakeholders and teams to drive process improvements. Directs the development of strategic plans which ensure alignment of organizational objectives, business priorities, and process improvement initiatives. Serves as a lead advocate for continuous improvement by keeping abreast of cutting edge industry practices, standards, and benchmarks. Oversees large and complex change management activities associated with care delivery or clinical initiatives and directs team members in performing complex data analyses to drive care delivery or clinical initiatives.

Essential Responsibilities:

• Prepares individuals for growth opportunities and advancement; builds internal collaborative networks for self and others. Solicits and acts on performance feedback; drives collaboration to set goals and provide open feedback and coaching to foster performance improvement. Demonstrates continuous learning; oversees the recruitment, selection, and development of talent; ensures performance management guidelines and expectations to achieve business needs. Stays up to date with organizational best practices, processes, benchmarks, and industry trends; shares best practices within and across teams. Motivates and empowers teams; maintains a highly skilled and engaged workforce by aligning resource plans with business objectives. Provides guidance when difficult decisions need to be made; creates opportunities for expanded scope of decision making and impact.
• Oversees the operation of multiple units within a department by identifying member and operational needs; ensures the management of work assignment completion; translates business strategy into actionable business requirements; ensures products and / or services meet member requirements and expectations while aligning with organizational strategies. Gains cross-functional support for business plans and priorities; assumes responsibility for decision making; sets standards, measures progress, and fosters resolution of escalated issues. Communicates goals and objectives; analyzes resources, costs, and forecasts and incorporates them into business plans; prioritizes and distributes resources. Removes obstacles that impact performance; guides performance and develops contingency plans accordingly; ensures teams accomplish business objectives.
• Directs the delivery, execution, and sustainment of process improvement (PI) engagements including kaizen by guiding the use of advanced methods and tools to ensure the development of stakeholder capabilities for process change and improvement; overseeing the deployment of data-driven PI principles, tools, and problem-solving methods including Lean/Six Sigma concepts and techniques; guiding high performance team capabilities to harness collective intelligence and take quick action to test ideas and achieve real time business results; directing the design and development of process architecture and recommendation documents; taking accountability for realization of results; and presenting results and recommendations to senior and/or executive management as appropriate.
• Ensures consultation is provided to stakeholders and process owners by building and nurturing trusted partnerships between stakeholders and teams to drive process improvements; directing the development of management systems to sustain process changes; empowering a culture of learning to drive stakeholder process improvement leadership competencies; directing stakeholder training to set the future direction of KP; and providing ongoing coaching to senior and executive management in order to build a continuous improvement mindset and culture, and to build capabilities that drive results.
• Directs the development of strategic plans which ensure alignment of organizational objectives, business priorities and process improvement initiatives by ensuring performance metrics, standards, and methods are defined, developed, and evaluated to establish process success and drive future growth; partnering with executive stakeholders, often with competing/conflicting objectives, to ensure cohesive and reachable metrics; reviewing and refining strategic plans and performance metrics as appropriate to establish the long‑term direction; and overseeing a portfolio of diverse and complex initiatives to ensure delivery of measurable results and alignment with strategic objectives.
• Serves as a lead advocate for continuous improvement by keeping abreast of cutting edge industry practices, standards, and benchmarks; attending and presenting at roadshows, conferences, and speaking events; leading the ongoing enhancement of process improvement practices, standards, and methods across KP; and serving as an advocate to ensure continuous learning and improvement is championed as a people strategy.
• Oversees large and complex change management activities associated with care delivery or clinical initiatives by engaging and influencing stakeholders to obtain support and buy in for changes; partnering with executive management, project champions, and clinical owners to communicate and align improvement initiatives with strategic objectives; deploying appropriate change management method and approach to ensure future organizational growth and capability; and ensuring stakeholders embrace a change management mindset, understand intent and purpose, and foster a culture of change.
• Directs team members in performing complex data analyses to drive care delivery or clinical initiatives by guiding team members to employ appropriate data analysis tools and approach to assess performance; empowering team members to utilize 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; and forecasting and alleviating risks through data-driven analysis.

Knowledge, Skills and Abilities: (Core)

• Ambiguity/Uncertainty Management
• Attention to Detail
• Business Knowledge
• Communication
• Constructive Feedback
• Critical Thinking
• Cross-Group Collaboration
• Decision Making
• Dependability
• Diversity, Equity, and Inclusion Support
• Drives Results
• Facilitation Skills
• Health Care Industry
• Influencing Others
• Integrity
• Leadership
• Learning Agility
• Organizational Savvy
• Problem Solving
• Short- and Long-term Learning & Recall
• Strategic Thinking
• Team Building
• Teamwork
• Topic-Specific Communication

Knowledge, Skills and Abilities: (Functional)

• Applied Data Analysis
• Business Acumen
• Business Process Improvement
• Emotional Intelligence
• Managing Diverse Relationships
• Negotiation
• Project Management
• Service Focus
• Written Communication

Minimum Qualifications:

• Minimum three (3) years experience in a leadership role with direct reports.
• Bachelors degree in Business Administration, Finance, Engineering, Health Care/Public Health Administration, Behavioral/Social/Computer Science, Liberal Arts, Mathematics, or related field and minimum ten (10) years progressive corporate, non-profit, project management or consulting experience, including minimum five (5) years in process improvement or directly related field OR Minimum thirteen (13) years progressive corporate, non-profit, project management or consulting experience, including minimum five (5) years in process improvement or directly related field.

Preferred Qualifications:

• Five (5) years of experience working as a broker or consultant in a market facing role for health plans.
• Five (5) years of experience working with health plan eligibility.