Clinical Quality Nurse Consultant

Blue Cross and Blue Shield of Kansas•Work at Home - Missouri, MO

8d•$73,920 - $92,400•Hybrid

About The Position

The Clinical Quality Nurse Consultant serves as a clinical liaison between Blue Cross Blue Shield of Kansas (BCBSKS), providers, and members to support quality improvement, care coordination, and value-based care initiatives across all lines of business. This role partners with providers and internal teams to implement data-informed clinical processes, improve quality outcomes, and support regulatory and accreditation requirements. The Nurse Consultant provides clinical expertise in quality measurement, HEDIS performance, and care coordination while advancing organizational goals related to quality, affordability, and member experience. This position reports to the Manager, Clinical Quality & Accreditation. “This position is eligible to work remotely, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

Requirements

Associate Degree in Nursing (ADN) required.
Current unrestricted Kansas Registered Nurse (RN) licensure required.
Minimum of 5 years of RN clinical experience required.
Certified Professional Coder (CPC) certification required within two years of hire.
Strong clinical knowledge and understanding of quality improvement principles and healthcare delivery systems.
Ability to communicate effectively with providers, internal stakeholders, and external partners.
Ability to work independently, prioritize work, and adapt to changing priorities.
Ability to analyze clinical information and identify trends or improvement opportunities.
Working knowledge of provider practice patterns, utilization, and care coordination models.
Understanding of business continuity and departmental recovery expectations.
Ability to sit or stand for extended periods.
Ability to look at a computer screen for prolonged periods.
Occasional walking, bending, or reaching within the office environment.
Ability to lift and carry up to 15 pounds.

Nice To Haves

Bachelor’s in nursing or health related field preferred.
Minimum 3 years' experience in clinical quality improvement or quality measurement activities, preferred.

Responsibilities

Support clinical quality improvement and value-based care initiatives by partnering with providers and internal teams to improve quality outcomes across assigned populations and lines of business.
Provide clinical expertise related to quality measurement, including HEDIS metrics, care coordination strategies, and performance improvement activities.
Collaborate with provider offices to implement workflows, tools, and processes that support population health management, care coordination, and quality gap closure.
Participate in quality oversight activities, including medical record reviews and peer review processes, serving as a clinical resource for committees such as the Administrative Quality Committee (AQC) as assigned.
Prepare and contribute to quality reports, summaries, and presentations supporting departmental, divisional, and corporate quality objectives.
Collaborate with cross-functional teams to identify trends, opportunities, and educational needs related to quality measurement and clinical performance.
Support compliance with applicable regulatory and accreditation standards as part of routine clinical quality activities.
Serve as a clinical resource for internal staff, providers, and external partners related to quality improvement programs and care coordination solutions.
Contribute to the development and maintenance of policies, procedures, and training materials supporting clinical quality improvement and reporting activities.