Director, Process Improvement, Risk Adjustment Oversight

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.

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.

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.

• 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…