Clinical Practice Consultant

Blue Cross of Idaho•Bozeman, MT

2d•$78,064 - $117,095

About The Position

Our Clinical Practice Consultants are responsible for the value creation, impact, and cost control of Blue Cross of Idaho provider partners engaged in value based reimbursement programs. Provide strategic, hands-on, office based support to primary care providers (PCP) for analysis of performance in quality, cost, and utilization scores, and identify opportunities for improvement across those areas. Develop strategic plans in collaboration with PCPs and the interdepartmental teams for transformation of workflows resulting in outstanding performance in the organization’s value based reimbursement program(s). We are looking for a Clinical Practice Consultant with: Experience: 5 years primary/ambulatory care environment, health industry, healthcare administration, population health management, or related experience Education: Bachelor’s Degree Nursing, Healthcare Administration, Public Health, Business Administrations, related course of study, or equivalent work experience (Two years’ relevant work experience is equivalent to one-year college) Other: Travel required Your day may look like: Deliver office based, hands on consultative workflow transformation and training/education services to providers enrolled in Blue Cross of Idaho value based reimbursement programs and clinical evidence based guidelines Identify, develop, and implement clinical cost and quality improvement projects based on claims, utilization, and medical cost data review in accordance with regulatory agency standards and accreditation agency requirements. Identify and lead performance improvement projects that maximize provider value based reimbursement. Evaluate the effectiveness of each project and assure implementation of corrective action plans that improve performance. Transform PCP practices enrolled in value based reimbursement program(s) using innovative continuous improvement methodologies. Analyze and interpret provider value based reimbursement reports in the areas of National Quality Standards like NCQA, HEDIS, NQF, PQRS etc. Develop strategic plans to meet target performance metrics, and implement strategic plans in partnership with the provider and plans. Provide assistance in the use of health information data exchanges, user interfaces, predicative analytic tools, and other population health management tools. Identify business requirements for Blue Cross of Idaho data analytics that support provider partners in identifying and meeting value based reimbursement targets Educate value based care providers regarding alternative care programs and research available options including costs and appropriateness of patient placement.

Requirements

5 years primary/ambulatory care environment, health industry, healthcare administration, population health management, or related experience
Bachelor’s Degree Nursing, Healthcare Administration, Public Health, Business Administrations, related course of study, or equivalent work experience (Two years’ relevant work experience is equivalent to one-year college)
Travel required
Program design and process improvement
Excellent written and verbal communication
Strong relationship management and facilitation
Work independently and proactively
Design and develop quality performance programs
Develop and deliver professional presentations on findings
Compare trends over time and find opportunities for improvement
Travel up to 25%

Nice To Haves

Experience in data analysis, interpretation, and outcomes strategic plan development
Experience in health plan provider network performance management, population health management, continuous improvement or provider engagement models
Experience with value based reimbursement programs

Responsibilities

Deliver office based, hands on consultative workflow transformation and training/education services to providers enrolled in Blue Cross of Idaho value based reimbursement programs and clinical evidence based guidelines
Identify, develop, and implement clinical cost and quality improvement projects based on claims, utilization, and medical cost data review in accordance with regulatory agency standards and accreditation agency requirements.
Identify and lead performance improvement projects that maximize provider value based reimbursement.
Evaluate the effectiveness of each project and assure implementation of corrective action plans that improve performance.
Transform PCP practices enrolled in value based reimbursement program(s) using innovative continuous improvement methodologies.
Analyze and interpret provider value based reimbursement reports in the areas of National Quality Standards like NCQA, HEDIS, NQF, PQRS etc.
Develop strategic plans to meet target performance metrics, and implement strategic plans in partnership with the provider and plans.
Provide assistance in the use of health information data exchanges, user interfaces, predicative analytic tools, and other population health management tools.
Identify business requirements for Blue Cross of Idaho data analytics that support provider partners in identifying and meeting value based reimbursement targets
Educate value based care providers regarding alternative care programs and research available options including costs and appropriateness of patient placement.