Clinical Practice Consultant

🔥 5 minutes ago

🏈 Alabama, Connecticut, +8 more states – Remote

🏈 Alabama – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🎸 Mississippi – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote

💵 $76.6k - $138.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💼 Consultant

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Health Care Service Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Health Care Service Corporation is an independent licensee of the Blue Cross Blue Shield Association, serving nearly 23 million people across the United States with a wide range of health benefit solutions. The company provides health coverage options for various groups, including employers, individuals, families, as well as Medicare and Medicaid plans. In addition to health insurance, HCSC offers services such as pharmacy solutions, life and dental insurance, and health data technology. With nearly a century of experience, HCSC is dedicated to improving access to quality care, enhancing health outcomes, and reducing costs while maintaining a deep commitment to its members and local communities.

📋 Description

• Support HCSC's quality imperatives, value-based care models, and provider relationships • Collaboratively work with assigned medical practices or individual PCPs, the appropriate Medical Director and Clinic Directors, and medical and non-medical quality staff • Improve key targeted HEDIS measures • Participate in model and program development • Conduct clinical readiness assessments • Support entity- and network-management-led joint operating committees • Obtain EMR access • Implement provider-based member outreach initiatives and provider supplemental data submissions • Retrieve key medical records throughout the year • Provide ongoing and annual evaluation of the effectiveness of the overall quality improvement program for the assigned line of business • Create and maintain strong working relationships with care coordination and care management teams at the value-based entity, local Network Management, and internal Clinical Operations teams • Provide consultative support and ensure operational needs are being met • Travel, including overnight stays

🎯 Requirements

• Registered Nurse (RN) OR Physician's Assistant OR Nurse Practitioner with current, unrestricted license to practice in the state of operations • 4 years’ experience in health insurance, managed care or medical group insurance experience • Knowledge of federal and accreditation standards and regulations for the health insurance industry • Experience in designing clinical programs • Experience conducting presentations for member and/or provider training • Proven ability to work collaboratively with physicians • Ability to work independently • Effective communication and written skills and ability to communicate and influence internal and external customers at all levels of the organization • PC skills and familiarity with various software packages including spreadsheets and presentations • Ability to travel, including overnight stays • Sponsorship is not available • Preferred: Currently resides in Florida, Georgia, Alabama, Mississippi, South Carolina, North Carolina, New Mexico, Pennsylvania, Delaware, New York, New Jersey, or Connecticut • Preferred: Ability to commit to local travel 20% or less to engage with various hospital systems • Preferred: Demonstrated success improving HEDIS, STAR, quality, or performance metrics through provider engagement and operational improvements • Preferred: Experience supporting population health or value-based care initiatives within a health plan, medical group, or healthcare system • Preferred: Experience analyzing clinical and operational performance data to identify opportunities for quality improvement • Preferred: Proven ability to build trusted relationships and influence clinical and operational stakeholders • Preferred: Experience leading practice transformation, workflow improvement, or quality performance initiatives

🏖️ Benefits

• Health and wellness benefits • 401(k) savings plan • Pension plan • Paid time off • Paid parental leave • Disability insurance • Supplemental life insurance • Employee assistance program • Paid holidays • Tuition reimbursement • Other incentives • Annual incentive bonus plan