Population Health Clinical Consultant - Registered Nurse

Capital Blue Cross•Harrisburg, PA

19h

About The Position

The Population Health Sales Consultant is an internal and external customer facing health care professional who works directly with Health Promotion & Wellness consultants, Sales, Care Management, and employer group customers to implement strategies and interventions to improve member health outcomes. The individual will lead key population health assessment projects using available analytical tools including Theon, consult with customers on population health strategy development and facilitate targeted interventions across the care delivery team to quantitatively improve health outcomes. The Consultant works with their assigned customer base in leveraging all available analytical tools, including Theon, to identify opportunities for clinical intervention, recommend strategies to address the identified opportunities and assist in the identification of optimal clinical support and programming. The Consultant will serve as a liaison between the customer and the clinical teams available to support their needs. Additionally, the individual will lead initiatives focused on health promotion and wellness, quality strategy, population health and medical value analysis, and provide data-driven reporting, while maintaining compliance with accreditation and regulatory requirements. The individual will research and employ nationally recognized quality standards and metrics; analyze quality outcomes; and assist with development of data collection.

Requirements

Ability to operate personal computer and proficiency in Microsoft word/excel/access applications.
Ability to conduct research using the internet as directed by management.
Ability to communicate professionally, clearly and effectively, through written/electronic means as well as oral communications with internal and external audiences.
Demonstrates the ability to develop rapport effectively and maintain strong interpersonal relationships internally and externally.
Ability to prioritize workload and assignments and perform accurate detailed and timely completion of assigned duties.
Maintains Member confidentiality at all times.
Shows sound judgment that affirms the rights and responsibilities of members/participants, families, health care professionals and health care organizations.
Knowledge of managed care products and processes, preferred.
Maintains current knowledge of evidence-based care management and behavioral change models.
Understands and complies with URAC, NCQA, CMS, ERISA, and all applicable state requirements.
5 years of clinical experience
Registered Nurse with active License.
Licensure must be in good standing.
Bachelor’s degree in health care is strongly preferred
While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
The employee must be able to complete job priorities and functions which may result in working over 37.5 hours per week.
The employee must occasionally lift and/or move up to 5 pounds.

Nice To Haves

Knowledge of motivational interviewing and behavioral change models, preferred.
Prior analytic experience and proficiency with analytic tools and/or provider EHR’s preferred.
Certification as CCM or CCP is preferred.

Responsibilities

Implement the population health framework for assigned customers and populations of focus to effectively improve overall health and utilization patterns including gaps in care, ED utilization, inpatient admissions and readmissions along with other key metrics for their entire population.
Develop and maintain knowledge of current customer contract(s) and performance guarantees.
Maintain up-to-date knowledge of the customer’s specific resources, and community resources available to assist in addressing identified needs and opportunities for assigned populations.
Develop and maintain an effective working relationship by meeting regularly with customers to foster opportunities to improve health and well-being of customer population.
Serve as a liaison between all parties to the population health initiative assigned, to prevent duplication and promote effective management of the assigned population.
Refer members to the appropriate programs to meet the member’s needs. This may include internal and external care management and vendored programs.
Integrate Triple Aim principals to improve member health outcomes and experience of care achieved per dollar spent.
Measurably impact member health, experience of care and the delivery of medical value through the relationships, programs and initiatives with hospitals, facilities, providers and provider groups.
Identifies and reports quality of care issues in accordance with established departmental policies and procedures.
Fully leverage all data and reporting tools in performance of duties to include Facets, Trucare, Theon, Salesforce, and employer group reporting/HUB.
Actively participate in Theon development and improvement initiatives to support ongoing clinical initiatives and efforts.