Clinical Practice Consultant

Health Care Service Corporation•Richardson, TX

1d•$70,600 - $149,600•Remote

About The Position

This position is a field-based quality role responsible for supporting HCSC's quality imperatives, value-based care models, and provider relationships by collaboratively working with assigned medical practices or individual PCPs, the appropriate Medical Director and Clinic Directors, and all medical and non-medical quality staff to improve key targeted HEDIS measures. This position involves model and program development, clinical readiness assessments, entity- and network-management-led joint operating committees, obtaining EMR access, implementing provider-based member outreach initiatives and provider supplemental data submissions, and retrieving key medical records throughout the year. The role provides ongoing and annual evaluation of the effectiveness of the overall quality improvement program for the assigned line of business. It is also responsible for creating and maintaining strong working relationships with the care coordination and care management teams at the value-based entity, as well as with local Network Management and internal Clinical Operations teams, providing consultative support and ensuring operational needs are being met.

Requirements

Registered Nurse (RN) OR Physician's Assistant OR Nurse Practitioner with current, unrestricted license to practice in the state of operations.
4 years’ experience in health insurance, managed care or medical group insurance experience.
Knowledge of federal and accreditation standards and regulations for the health insurance industry.
Experience in designing clinical programs.
Experience conducting presentations for member and/or provider training.
Proven ability to work collaboratively with physicians.
Ability to work independently.
Effective communication and written skills and ability to communicate and influence internal and external customers at all levels of the organization.
PC skills and familiarity with various software packages including spreadsheets and presentations.
Ability to travel includes overnight stays.

Nice To Haves

Currently resides in Florida, Georgia, Alabama, Mississippi, South Carolina, North Carolina, Pennsylvania, Delaware, New York, New Jersey, or Connecticut.
Ability to commit to local travel 20% or less to engage with various hospital systems.
Demonstrated success improving HEDIS, STAR, quality, or performance metrics through provider engagement and operational improvements.
Experience supporting population health or value-based care initiatives within a health plan, medical group, or healthcare system.
Experience analyzing clinical and operational performance data to identify opportunities for quality improvement.
Proven ability to build trusted relationships and influence clinical and operational stakeholders.
Experience leading practice transformation, workflow improvement, or quality performance initiatives.

Responsibilities

Support HCSC's quality imperatives, value-based care models, and provider relationships.
Collaborate with assigned medical practices or individual PCPs, Medical Director, Clinic Directors, and quality staff to improve key targeted HEDIS measures.
Involve model and program development.
Conduct clinical readiness assessments.
Participate in entity- and network-management-led joint operating committees.
Obtain EMR access.
Implement provider-based member outreach initiatives and provider supplemental data submissions.
Retrieve key medical records throughout the year.
Provide ongoing and annual evaluation of the effectiveness of the overall quality improvement program for the assigned line of business.
Create and maintain strong working relationships with care coordination and care management teams at the value-based entity, as well as with local Network Management and internal Clinical Operations teams.
Provide consultative support and ensure operational needs are being met.