Provider Clinical Liaison (Nurse Auditor)

Elevance Health•Visalia, CA

6d•$43 - $77•Hybrid

About The Position

Provider Clinical Liaison (Nurse Auditor) Location: Selected candidate must reside in the State of California. Field: This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. 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 an accommodation is granted as required by law. The Provider Clinical Liaison is responsible for Patient Centered Care (PC2) program implementation focusing on partnering and building relationships with providers and their office staff to support their understanding of disease and case management. How you will make an impact: Serves as the clinical point of contact for providers and primary care practices for orientation, on-going training, and support for the practice's clinical coordination and care management team regarding company clinical programs and case management concepts. Conducts clinical review meetings with physician office staff and internal staff. Works in collaboration with the PC2 team on program review, evaluation and program design enhancements. Serves as the subject matter expert for primary care practices on all Care Management programs for all lines of business and care management programs (i.e., CM, DM, Senior, Nurse Line). Partners with case/disease management departments to facilitate clinical processes between the company and provider offices. Serves as a liaison with state/region provider contracting account managers and other associates.

Requirements

Requires BA/BS in Nursing and minimum of 5 years of medical management experience; or any combination of education and experience, which would provide an equivalent background.
Current unrestricted RN license required.

Nice To Haves

MS or advanced degree preferred.
1 year experience in quality and/or risk management.
Experience conducting mandated facility site reviews and medical record audits highly preferred.
Highly proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint), experienced with Electronic Health Records (EHR), and knowledgeable in medical terminology.

Responsibilities

Serves as the clinical point of contact for providers and primary care practices for orientation, on-going training, and support for the practice's clinical coordination and care management team regarding company clinical programs and case management concepts.
Conducts clinical review meetings with physician office staff and internal staff.
Works in collaboration with the PC2 team on program review, evaluation and program design enhancements.
Serves as the subject matter expert for primary care practices on all Care Management programs for all lines of business and care management programs (i.e., CM, DM, Senior, Nurse Line).
Partners with case/disease management departments to facilitate clinical processes between the company and provider offices.
Serves as a liaison with state/region provider contracting account managers and other associates.