Clinical Practice Consultant

Medicare; Richardson (TX); Remote; USD 71,000 - 150,000; Full time

Job summary

HCSC invites experienced healthcare professionals to join a fully remote field-based quality role in the United States. The position supports quality imperatives, value-based care models, and provider relationships with PCPs and medical directors to improve HEDIS measures.

The role involves program development, readiness assessments, data submissions, and collaboration with care coordination teams across the value-based entity. Travel including overnights is required.

Qualifications

• 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.

Responsibilities

• Support HCSC's quality imperatives and value-based care models with providers.
• Collaborate with Medical Directors, Clinic Directors and quality staff to improve targeted HEDIS measures.
• Develop and evaluate clinical programs and provider outreach initiatives.
• Obtain EMR access and coordinate data submissions and records retrieval throughout the year.

Skills

RN/PA/NP

Independent worker

Communication skills

Travel readiness

Education

Unrestricted license (RN/PA/NP)

Tools

MS Office Suite

EMR systems

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to 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 will invest in your professional development.

This position is a field-based quality role responsible for supporting HCSC's quality imperatives, value-based care models, and provider relationships by collaboratively working with assigned medical practices or individual PCPs, the appropriate Medical Director and Clinic Directors, and all medical and non-medical quality staff to improve key targeted HEDIS measures. This position involves model and program development, clinical readiness assessments, entity- and network-management-led joint operating committees, obtaining EMR access, implementing provider-based member outreach initiatives and provider supplemental data submissions, and retrieving key medical records throughout the year. The role provides ongoing and annual evaluation of the effectiveness of the overall quality improvement program for the assigned line of business. It is also responsible for creating and maintaining strong working relationships with the care coordination and care management teams at the value-based entity, as well as with local Network Management and internal Clinical Operations teams, providing consultative support and ensuring operational needs are being met.

Required Job Qualifications

• 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 includes overnight stays.

Preferred Job Qualifications

• Currently resides in Florida, Georgia, Alabama, Mississippi, South Carolina, North Carolina, New Mexico, Pennsylvania, Delaware, New York, New Jersey, or Connecticut.
• Ability to commit to local travel 20% or less to engage with various hospital systems.
• Demonstrated success improving HEDIS, STAR, quality, or performance metrics through provider engagement and operational improvements.
• Experience supporting population health or value-based care initiatives within a health plan, medical group, or healthcare system.
• Experience analyzing clinical and operational performance data to identify opportunities for quality improvement.
• Proven ability to build trusted relationships and influence clinical and operational stakeholders.
• Experience leading practice transformation, workflow improvement, or quality performance initiatives.

This is a fully remote position, available in the US only, not limited to the posting location.

Sponsorship is not available.

Compensation: $70,600.00 - $149,600.00

Exact compensation may vary based on skills, experience, and location

HCSC Employment Statement

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards