Clinical Practice Consultant

Health Care Service Corporation; Illinois; Remote; USD 69,000 - 147,000; Full time

Job summary

A leading health care organization is seeking a field-based quality role focused on enhancing quality measures and collaborating with medical teams. This remote position requires a licensed RN, PA, or NP with significant experience in health insurance. Responsibilities include model development, clinical assessments, and managing provider data. The role emphasizes strong communication and independent work, with a commitment to quality improvement in health care delivery.

Benefits

Health and wellness benefits

401(k)

Pension

Paid time off

Parental leave

Disability insurance

Life insurance

Tuition reimbursement

Qualifications

• At least 4 years of experience in health insurance or managed care.
• Knowledge of federal standards for health insurance.
• Proven ability to collaborate effectively with physicians.

Responsibilities

• Support quality imperatives and value-based care models.
• Collaborate with medical practices to improve HEDIS measures.
• Evaluate the effectiveness of the Quality Improvement Program.

Skills

Collaboration

Communication

Independence

Education

Registered Nurse (RN)

Physician's Assistant

Nurse Practitioner

Tools

Spreadsheets

Presentation tools

Job description

At HCSC, our employees are the cornerstone of our business and the foundation of our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that invests in your professional development.

Job Summary

This position is a field-based quality role responsible for supporting HCSC's quality imperatives and value-based care models. The role involves collaborating with assigned medical practices, PCPs, Medical Directors, Clinic Directors, and other staff to improve key HEDIS measures. Responsibilities include participating in model development, clinical readiness assessments, obtaining EMR access, implementing outreach initiatives, and managing provider data submissions and medical record retrieval. The role also involves evaluating the effectiveness of the Quality Improvement Program and maintaining strong relationships with care teams to support operational needs.

Required Job Qualifications:

• Registered Nurse (RN), Physician's Assistant, or Nurse Practitioner with a current, unrestricted license in the state of operation.
• At least 4 years of experience in health insurance, managed care, or medical group insurance.
• Knowledge of federal and accreditation standards and regulations for the health insurance industry.
• Experience designing clinical programs.
• Experience delivering presentations for member and provider training.
• Proven ability to collaborate effectively with physicians.
• Ability to work independently.
• Strong communication and written skills, with the ability to influence internal and external stakeholders at all levels.
• Proficiency with PC and familiarity with software including spreadsheets and presentation tools.
• Willingness and ability to travel, including overnight stays.

This is a remote role: Candidates must reside within 250 miles of the office or anywhere within the posted state.

#LI-Remote

#LI-MW2

Referral and Benefits

If referred by a connection at HCSC, inquire about our Employee Referral process.

Pay Transparency: We offer a comprehensive benefits package including health and wellness benefits, 401(k), pension, paid time off, parental leave, disability insurance, life insurance, employee assistance, holidays, tuition reimbursement, and more. Details are available at https://careers.hcsc.com/totalrewards.

Compensation varies based on skills, education, and experience, and may include an annual incentive bonus, subject to plan terms.

HCSC Employment Statement

We are an Equal Opportunity Employer committed to a diverse and inclusive environment. All qualified applicants will receive consideration regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics.

Base Pay Range

$69,200.00 - $146,700.00