Clinical Practice Consultant

This is a fully remote position, open to applicants in Alabama, +9 more states.

📋 Description

• Assist in fulfilling HCSC's quality objectives, value-based care frameworks, and provider collaborations.

• Work collaboratively with designated medical practices or individual PCPs, along with the relevant Medical Director, Clinic Directors, and both medical and non-medical quality personnel.

• Enhance specific targeted HEDIS metrics.

• Engage in the development of models and programs.

• Perform clinical readiness evaluations.

• Support joint operating committees led by entity- and network-management.

• Secure access to EMR systems.

• Execute provider-centric member outreach initiatives and manage provider supplemental data submissions.

• Collect essential medical records throughout the year.

• Conduct continuous and annual assessments of the effectiveness of the overall quality improvement program for the designated line of business.

• Foster and sustain strong working relationships with care coordination and care management teams at the value-based entity, local Network Management, and internal Clinical Operations teams.

• Offer consultative assistance and ensure that operational needs are addressed.

• Travel may be required, including overnight stays.

⛳️ Requirements

• Registered Nurse (RN) OR Physician's Assistant OR Nurse Practitioner with a current and unrestricted license to practice in the state of operation.

• A minimum of 4 years of experience in health insurance, managed care, or medical group insurance.

• Familiarity with federal and accreditation standards and regulations pertaining to the health insurance sector.

• Experience in the design of clinical programs.

• Background in delivering presentations for member and/or provider training.

• Demonstrated ability to collaborate effectively with physicians.

• Capability to work independently.

• Strong communication and writing skills, with the ability to engage and influence internal and external stakeholders at all organizational levels.

• Proficiency in PC skills and knowledge of various software applications, including spreadsheets and presentation tools.

• Willingness to travel, including overnight stays.

• Sponsorship is not available.

• Preferred: Residing 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 of 20% or less to interact with various hospital systems.

• Preferred: Proven track record of enhancing HEDIS, STAR, quality, or performance metrics through provider engagement and operational improvements.

• Preferred: Experience in supporting population health or value-based care initiatives within a health plan, medical group, or healthcare system.

• Preferred: Proficient in analyzing clinical and operational performance data to identify quality improvement opportunities.

• Preferred: Proven capability in building trusted relationships and influencing clinical and operational stakeholders.

• Preferred: Experience in leading practice transformation, workflow enhancements, 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.

• Additional incentives.

• Annual incentive bonus plan.