Clinical Practice Consultant - Work From Home

HCSC•Albuquerque, NM

4d•Remote

About The Position

This position is a field-based quality position, responsible for supporting HCSC’s quality imperatives and value-based care models and 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 and other staff to improve key targeted HEDIS measures. This position participates in model/program development, clinical readiness assessments of entity and network management led joint operating committees, obtaining EMR access, implementing provider-based member outreach initiatives and provider supplemental data submissions, and retrieval of key medical records throughout the year. This role provides ongoing and annual evaluation of the effectiveness of the overall quality improvement program for the line of business assigned and is also responsible for creating and maintaining strong working relationships with the care coordination/care management teams at the value based entity and internally with local network management and internal clinical operations teams to provide consultative support and ensure day to day 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

Responsibilities

Supporting HCSC’s quality imperatives and value-based care models and relationships
Collaboratively working with assigned medical practices or individual PCPS, the appropriate medical director and clinic directors and all medical and non-medical quality and other staff to improve key targeted HEDIS measures
Participating in model/program development
Clinical readiness assessments of entity and network management led joint operating committees
Obtaining EMR access
Implementing provider-based member outreach initiatives and provider supplemental data submissions
Retrieval of key medical records throughout the year
Providing ongoing and annual evaluation of the effectiveness of the overall quality improvement program for the line of business assigned
Creating and maintaining strong working relationships with the care coordination/care management teams at the value based entity and internally with local network management and internal clinical operations teams to provide consultative support and ensure day to day operational needs are being met.