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Business Process Consultant

Woodland Hills, California Apply Now Job ID 1159201 Additional Locations US,California;Rancho Cordova Category Administrative Services Organization Health Net of California Schedule Full-time
Position Purpose: The Business Process Consultant leads large scale, cross-functional initiatives.

  • Work with provider groups, vendors and others to identify the gaps and develop necessary programs.
  • Participate in vendor relationships and analyzes program results to ensure retrospective and prospective programs are meeting expectations. Ensures Vendors are compliant with contract terms and other regulatory requirements.
  • Works with Actuaries and Vendor consultants to calculate Risk Adjustment accruals on a regular/monthly basis.
  • Performs detailed analysis of data, workflows, policies, procedures, organization of staff, skills and offer potential solutions in order to execute initiatives.
  • Prepares and analyzes financial reports to report actual costs of programs vs. budget.
  • Attends industry conferences in order to keep abreast of changes in regulations and industry trends.
  • Coordinates operations with Med Mgmt, STARS and Provider Network Mgmt in order to optimize touch points with members and providers.
  • Facilitates the optimization of business unit performance by enhancing alignment of policy, process and technology and designing/implementing for future business needs as well.
  • Provides policy guidance on assigned initiatives so that end-to-end processes are considered for maximizing effective implementation.
  • Assists business case development for those proposed initiatives to which are assigned to ensure adequate assessment of opportunities, risks and gaps.
  • Leads large scale, cross-functional initiatives that are intended to drive performance improvement, financial gains, customer satisfaction and improved compliance.
  • Organizes work teams, drives consensus and ensures end-to-end policy/process integrity to accomplish project work including: identification and confirmation of participants, establishment of a project plan, consistent work team engagement and productivity, meeting facilitation, consensus building, recommendation documentation and implementation oversight.
  • Supports the project work by utilizing project management software such as, but not limited to, Excel, PowerPoint, Visio, and Microsoft Project.
  • Leads all levels of staff who are responsible for initiatives included in the company’s operating plan in order to support their success, development and effective completion and communication of their initiatives.
  • Assists other project leaders in specific areas as needed such as facilitation, analysis, process mapping, brain-storming, project management issues, etc.
  • Writes and delivers communication to all levels of organization to ensure support, awareness and effectiveness of process improvement initiatives.
  • Provides other related support as needed to improve the performance of the business.
  • Qualifications:


    Bachelor’s degree in related field or equivalent experience.  Master’s degree preferred. Five or more years of related project or program management experience, preferably in health care and/or insurance. Demonstrated experience and skill in training, presenting and facilitating.  

    Additional preferred experience & skills:
    • Personal computer skills with proficiency using Microsoft Office software (intermediate level or higher)
    • Ability to work with cross-functional teams and build effective working relationships
    • Excellent organizational skills
    • Excellent verbal and written communication skills
    • Ability to analyze, interpret, apply and communicate policies, procedures and regulations
    • Strong analytical skills with attention to detail
    • Proactive problem solving skills and experience

    Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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