Managerial Consultant V, Risk Adjustment Strategy & Performance

Overview: The Managerial Consultant V, Risk Adjustment Strategy & Performance, is responsible for leading the development, implementation, and optimization of strategic initiatives that advance National Health Plan Risk Adjustment performance, with a particular focus on Medicaid Risk Adjustment strategy. Reporting to the Executive Director of Strategic Planning & Oversight, this role partners closely with cross-functional leaders across operations, analytics, finance, clinical, and market teams to identify opportunities, drive execution, and deliver measurable business outcomes. The consultant leverages deep risk adjustment expertise, strong analytical capabilities, and strategic thinking to translate complex data into actionable insights and compelling executive-level narratives that inform decision-making and organizational direction. This position plays a key role in shaping enterprise risk adjustment strategy, leading performance improvement initiatives, and developing high-impact presentations and communications for senior leadership.

Job Summary:

Serves as a lead consultant to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive the implementation of strategic business initiatives and projects/programs across multiple functional tracks or workstreams. Drives business strategy, organizational alignment, and prioritization of business initiatives. Leads the work of project/program team members. Provides expertise and drives the development and implementation of business initiatives, systems, and/or processes to a desired future state. Manages complex, cross-functional projects/programs, and serves as an expert in the proactive monitoring and identification of client, project, program, and/or business risks. Designs, leads, and serves as an expert for change management plans associated with business initiatives. Leads assessment of strategic performance metrics to support business initiatives. Participates in vendor management as required. Monitors compliance of work activities by ensuring business plans and team members adhere to relevant policies and procedures.

Essential Responsibilities:

• Promotes learning in others by communicating information and providing advice to drive projects forward; builds relationships with cross-functional stakeholders. Listens, responds to, seeks, and addresses performance feedback; provides actionable feedback to others, including upward feedback to leadership and mentors junior team members. Practices self-leadership; creates and executes plans to capitalize on strengths and improve opportunity areas; influences team members within assigned team or unit. Adapts to competing demands and new responsibilities; adapts to and learns from change, challenges, and feedback. Models team collaboration within and across teams.
• Conducts or oversees business-specific projects by applying deep expertise in subject area; promotes adherence to all procedures and policies. Partners internally and externally to make effective business decisions; determines and carries out processes and methodologies; solves complex problems; escalates high-priority issues or risks, as appropriate; monitors progress and results. Develops work plans to meet business priorities and deadlines; coordinates and delegates resources to accomplish organizational goals. Recognizes and capitalizes on improvement opportunities; evaluates recommendations made; influences the completion of project tasks by others.
• Serves as a lead consultant to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive the implementation of strategic business initiatives and projects/programs across multiple functional tracks or workstreams by identifying and ensuring representation and inclusion of appropriate stakeholders; building rapport and partnerships with key stakeholder teams, third party vendors, and executive management; working with stakeholders to develop goals and set the prioritization of deliverables; developing a menu of solutions for complex, competing, or ambiguous requests; discussing involvement of business processes (e.g. change management, communication) and facilitating decisions necessary for the delivery of business initiatives; communicating and resolving tough issues with stakeholders while maintaining an independent perspective; and making formal presentations and providing reports to executive level audiences.
• Drives business strategy, organizational alignment, and prioritization of business initiatives by working closely with senior executives to facilitate the development, refinement, and articulation of the business strategy; defining, developing, and evaluating performance metrics, standards, and methods to establish business success; leading the development of strategic roadmaps for solution development and deployment; collaborating with senior cross-functional stakeholders, often with competing/conflicting objectives to ensure cohesive and reachable metrics; refining strategic plans and performance metrics as appropriate; and managing complex initiatives or portfolio to ensure delivery of measurable results and alignment with strategic objectives.
• Leads the work of project/program team members by requesting and coordinating internal and/ or external resources based on the alignment of team member skills and project/program demands; delivering and promoting strategic vision and objectives to team members; and delivering performance feedback to team members supervisors and leadership as appropriate.
• Develops requirements, or leads a team of consultants in the development of requirements for large-scale, complex, or specialized business, process, or system solutions across business domain(s) by partnering with stakeholders and cross-functional teams as appropriate; leveraging multiple business requirements gathering methodologies to identify business, functional, and non-functional requirements; and leading and overseeing the development and documentation of comprehensive business cases to assess the costs, benefits, and ROI of proposed solutions.
• Provides expertise and drives the development and implementation of business initiatives, systems, and/or processes to a desired future state by maintaining a comprehensive understanding of how current processes impact business operations across multiple domains; mapping current state against future state processes; leveraging stakeholder partnerships to identify the operational needs and impact of requirements on upstream and downstream solution components; providing options and recommendations to executive management and business stakeholders on how to integrate solutions and deliverables with current systems and business processes across regions and domains; identifying and validating value gaps and opportunities for process enhancements or efficiencies; and leading the establishment of appropriate governance and workgroup infrastructures to accomplish strategic outcomes.
• Manages complex, cross-functional projects and/or programs by coordinating stakeholders; recommending or assigning team resources based on project needs and team member strengths; consulting in the development, analysis, and management of project/program plans; collaborating on the coordination of project/program scope, schedules, and resource forecasts; proactively monitoring and identifying project/program/business initiative risks, issues, and trigger events; developing mitigation plans and strategies; and resolving or escalating risks or issues as appropriate.
• Serves as an expert in the proactive monitoring and identification of client, project, program, and/or business risks, issues, and trigger events by leading the development of mitigation plans and strategies; and resolving or escalating risks or issues as appropriate.
• Designs, leads, and serves as an expert for change management plans associated with business initiatives by engaging stakeholders to obtain support and buy in for changes; partnering with executive management, project/program champions, and business owners to communicate and align improvement initiatives with business objectives; identifying appropriate change management method and approach; and ensuring stakeholders embrace a change management mindset, understand intent and purpose, and foster a culture of change.
• Leads the assessment of strategic performance metrics to support business initiatives by building partnerships with data analytic teams to ensure the translation of business requirements into analytic specifications; identifying appropriate data analysis tools and approach to assess business performance; determining 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; conducting advanced statistical analyses and/or testing to evaluate the effectiveness of business solutions; and identifying and alleviating risks through data-driven analysis.
• Serves as a lead advocate for continuous learning and professional development by keeping abreast of cutting edge industry practices, standards, and benchmarks; attending and presenting at roadshows, conferences, training seminars, and/or speaking events as appropriate; leading the ongoing enhancement and innovation of consulting practices, standards, and methods across KP; serving as an advocate to ensure continuous learning and improvement is championed as a people strategy; providing training and guidance to stakeholders as appropriate; and providing ongoing coaching to build a continuous improvement mindset and build capabilities that drive results.
• Participates in vendor management as required by reviewing vendor performance levels; ensuring service level agreements are met; managing vendor invoices; and partnering with Procurement and/or Legal to develop service level and/or scope of work agreements as appropriate.
• Monitors compliance of work activities by ensuring business plans and team members adhere to KP, departmental, and/or business line policies and procedures.