Clinical Consultant III - Clinical Documentation - Coding

** CLINICAL DOCUMENTATION CONSULTANT III - MUST RESIDE WITHIN A KP-AUTHORIZED STATE/REGION **

Certified Coders - Certified Coders w/Risk Adjustment experience - Ideally w/Provider Education Experience!!!

IDEAL CANDIDATES FOR THIS ROLE WILL HAVE A CODING CERTIFICATION: CPC, CRC, CPMA OR SIMILAR HEALTHCARE CODING CERT

( KP-Authorized States - Must Live In: CA, CO, CT, DC, GA, HI, IL, MD, OR, VA, WA )

Job Summary:

Serves as part of a consultant team to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive successful initiatives and projects within clinical settings within a technical area or workstream. Provides insight and supports the development and implementation of clinical initiatives, systems, and/or processes to a desired future state. Supports clinical or care delivery strategy and organizational alignment and prioritization of clinical initiatives by defining, developing, and evaluating performance metrics. Manages moderately complex projects or project components, participates in change management activities, and performs data analyses in support of care delivery or clinical initiatives. Supports vendor management as required. Monitors compliance of work activities by ensuring project plans and team members adhere to relevant policies and procedures.

Essential Responsibilities:

Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.

Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.

Serves as part of a consultant team to ensure the alignment, buy-in, and coordination of diverse stakeholders to drive successful initiatives and projects within care delivery or clinical settings within a technical area or workstream by making significant contributions to projects to identify and resolve issues of importance to the organization; identifying and ensuring representation and inclusion of appropriate stakeholders and team members; building rapport and partnerships with stakeholder teams, third party vendors, and senior management to produce results that are outcome driven; working with stakeholders to develop goals and set the prioritization of deliverables; discussing involvement of key processes (e.g. quality management, project change management, communication) and facilitating decisions necessary for the delivery of initiatives; communicating tough issues to stakeholders while maintaining an independent perspective; developing written materials for senior management other key clients; and making formal presentations and providing reports to various audiences as appropriate.

Develops requirements for clinical, process, or system solutions within assigned technical area(s) by interfacing stakeholders and cross-functional teams as appropriate; leveraging multiple requirements gathering methodologies to identify clinical, functional, and non-functional requirements; developing and documenting comprehensive case studies to assess the costs, benefits, and ROI of proposed solutions.

Provides insight and supports the development and implementation of clinical initiatives, systems, and/or processes to a desired future state by maintaining a working understanding of how current processes impact clinical operations across one or more technical areas; mapping current state against future state processes; identifying the operational impact of requirements on upstream and downstream solution components; providing options and recommendations to management and clinical stakeholders on how to integrate solutions and deliverables with current systems and processes; and identifying and validating value gaps and opportunities for process enhancements or efficiencies.

Supports clinical or care delivery strategy and organizational alignment and prioritization of clinical initiatives by defining, developing, and evaluating performance metrics, standards, and methods to establish success; collaborating with multiple stakeholders, often with competing/conflicting objectives, to ensure cohesive and reachable metrics; and managing assigned initiatives or portfolio to ensure delivery of measurable results and alignment with strategic objectives.

Serves as an advocate of continuous learning and professional development by keeping abreast of industry practices, standards, and benchmarks; attending and participating in roadshows, conferences, and speaking events; contributing to the ongoing enhancement and innovation of clinical consulting practices, standards, and methods across KP; serving as an advocate to ensure continuous learning and improvement is championed as a people strategy; and providing training and guidance to stakeholders as appropriate.

Manages moderately complex projects or project components by coordinating stakeholder contacts; recommending or assigning team resources based on project needs and team member strengths; consulting in the development, analysis, and management of project plans, including proposed project structure, approach and work plan; coordinating project schedules and resource forecasts; proactively monitoring and identifying project or clinical initiative risks, issues, and trigger events; developing mitigation plans and strategies; and resolving or escalating risks or issues as appropriate.

Participates in change management activities associated with care delivery or clinical initiatives by engaging stakeholders to obtain support and buy in for changes; collaborating with management, project champions, and clinical owners to communicate and align improvement initiatives with strategic objectives; using appropriate change management methods and approaches; and ensuring stakeholders embrace a change management mindset, understand intent and purpose, and support a culture of change.

Performs data analyses to support care delivery or clinical initiatives by using appropriate data analysis tools and approach to assess performance; deploying 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 analyses and performing experimental tests to evaluate the effectiveness of clinical solutions; identifying and alleviating risks through data-driven analysis; and preparing and sharing data/analysis summaries and incorporating into action plans as appropriate.

Supports vendor management as required by assisting with reviews of vendor performance levels; ensuring service level agreements are met; 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 project plans and team members adhere to KP, departmental, and/or clinical policies and procedures.