Practice Consultant

Elevance Health • Walnut Creek, CA

5h • $40 - $63 • Hybrid

About The Position

Practice Consultant Locations: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. Monday – Friday 8-5 pm PST hours. The Practice Consultant is responsible for creating a partnership relationship with providers and other initiatives and implementing the concept of a Medical Home for our members to achieve this fully integrated and accountable system of care, while serving as a member advocate responsible for identifying and closing gaps in care access and coordination. How you will make an Impact: Assesses current practice patterns, assets and challenges utilizing Medical Home Index, NCQA Standards, HEDIS audits, site reviews and medical records reviews. In partnership with the PCP, evaluates results of the initial assessment. Establishes a project plan with the practice that establishes goals and objectives for improvement. Provides ongoing practice support and sustains the partnership. Establishes regular meetings to track progress. Acts as a care navigation liaison between members, providers, Member Services, and Case Management by facilitating follow-up care, wellness and preventive education, and addressing member needs that fall outside of catastrophic case management but exceed routine customer service. Improves the understanding and sensitivity to the unique needs of this population and the care givers, including proactive advocacy for timely, appropriate, and coordinated care.

Requirements

• Requires AS in nursing and minimum of 5 years of managed care experience and minimum of 2 years of clinical experience and minimum of 2 years of professional presentations to small and large audiences; or any combination of education and experience, which would provide an equivalent background.
• Current, unrestricted clinical license appropriate to field of specialty (LVN/LPN, RN, NP, PA, LCSW, LSW, etc.) as required.

Nice To Haves

• BSN or MSN is preferred.
• RN case management or UM experience is preferred.

Responsibilities

• Assesses current practice patterns, assets and challenges utilizing Medical Home Index, NCQA Standards, HEDIS audits, site reviews and medical records reviews.
• In partnership with the PCP, evaluates results of the initial assessment.
• Establishes a project plan with the practice that establishes goals and objectives for improvement.
• Provides ongoing practice support and sustains the partnership.
• Establishes regular meetings to track progress.
• Acts as a care navigation liaison between members, providers, Member Services, and Case Management by facilitating follow-up care, wellness and preventive education, and addressing member needs that fall outside of catastrophic case management but exceed routine customer service.
• Improves the understanding and sensitivity to the unique needs of this population and the care givers, including proactive advocacy for timely, appropriate, and coordinated care.

Benefits

• In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree