Nurse Consultant Clinical Quality Improvement

Blue Cross and Blue Shield of Kansas•Topeka, KS

9d•Hybrid

About The Position

The Nurse Consultant serves as a clinical liaison between BCBSKS, providers, and members to enhance care coordination, quality outcomes, and cost efficiency. This role supports provider offices in implementing data-driven processes and collaborating across internal teams to advance value-based care and CMS program goals. The Nurse Consultant promotes member engagement, leads educational sessions, and provides clinical expertise on HEDIS metrics and quality improvement initiatives to achieve better health, better care, and lower cost outcomes. “This position is eligible to work onsite, remote or hybrid (9 or more days a month on site) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.” Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas. Why Join Us Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans. Family Comes First : Total rewards package that promotes the idea of family first for all employees. Professional Growth Opportunities: Advance your career with ongoing training and development programs. Dynamic Work Environment: Collaborate with a team of passionate and driven individuals. Trust: Work for one of the most trusted companies in Kansas Stability: 80 years of commitment, compassion and community Flexibility: options to work onsite, hybrid or remote available Compensation $73,920 - $92,400 annually Exempt 15 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

Requirements

Ability to communicate effectively, verbally, in writing and via telephone with providers, internal staff, and external entities.
Ability to self-direct, make independent decisions, prioritizes daily activities.
Ability to solve problems independently or with minimal supervision.
Ability to be flexible and adapt to change in timely manner.
Awareness and understanding of current provider medical and utilization practices.
Responsible for maintaining an awareness and understanding of the business unit recovery plan for the department you work in and the corporation’s business continuity program in general.
Masters, Baccalaureate, Diploma or Associate Degree in Nursing required.
Current unrestricted Kansas RN licensure required.
Minimum of 5 years of RN clinical experience to include 3 years’ experience working on clinical quality improvement activities to improve HEDIS measures is required.
Must be Certified Professional Coder (CPC) by American Academy of Procedural Coders within two years of hire.

Responsibilities

Performs duties in conjunction with management to collaborate and coordinate Clinical Quality Improvement activities between numerous internal departments, and providers and clinic staff to improve individual member health as well as population health.
Leads clinical communications and correspondence as needed to implement the clinical quality improvement concepts in provider offices including training of vendor computer system, implementing data/tools/processes to manage member populations for care coordination, supporting development of internal and external policies and procedures, and developing program outcomes.
Works closely with team members of various departments to determine and implement the most efficient and effective processes that result in positive health outcomes for members.
Serves as a direct resource for development of care coordination solutions for BCBSKS staff, providers, employer groups, members, liaison committees, advisory committees, and related programs required by the Association.
Assist and support quality management programs that promote measurement, monitoring and evaluation of services and work processes to improve quality-based activities and outcomes.
Works with the Administrative Quality Committee (AQC) to conduct medical record reviews on all concerns and complaints regarding contracting provider/facility care to members.
Prepares AQC quarterly and annual reports.
Acts as the Peer Review Officer for AQC, conducts meetings on a monthly basis or more frequently if required by the AQC or case load, and works with external peer review organizations.
Maintains and verifies the accuracy of the case log for the AQC.
Collaborates with team members of various departments to identify trends and coordinate provider/member education regarding quality measurement and reporting.
Prepares quarterly and annual quality reports.
Works to establish goals and objectives to support Department, Division, and Corporate Objectives.
Develops meeting agendas and distributes meeting minutes.
Trains new and existing persons on tools used to support clinical quality improvement activities and reporting.
Maintains strong understanding of job-related activities and serves as resource expert for those activities for the corporation.
Must follow URAC standards as required for essential job functions.