Clinical Practice Consultant

Health Care Service Corporation; Springfield (IL); Remote; USD 69,000 - 147,000; Full time

Job summary

Join a purpose-driven company as a Quality Improvement Specialist, responsible for enhancing healthcare quality through collaboration with medical teams. This remote role requires a strong background in health insurance and effective communication skills. You'll work independently to support operational needs and improve patient care outcomes.

Benefits

Health and wellness benefits

401(k)

Pension

Paid time off

Parental leave

Disability insurance

Life insurance

Tuition reimbursement

Qualifications

• At least 4 years' experience in health insurance or managed care.
• Knowledge of federal standards for the health insurance industry.

Responsibilities

• Support HCSC's quality imperatives and value-based care models.
• Collaborate with medical practices to improve key HEDIS measures.
• Manage medical record retrieval and evaluate Quality Improvement Program.

Skills

Effective communication

Collaboration

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 medical practices, PCPs, Medical Directors, Clinic Directors, and other staff to improve key HEDIS measures. Responsibilities include participating in model/program development, clinical readiness assessments, obtaining EMR access, implementing provider outreach initiatives, and managing medical record retrieval. The role also involves evaluating the effectiveness of the Quality Improvement Program and maintaining strong relationships with care teams and internal departments 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' 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 conducting training presentations for members and/or providers.
• Proven ability to collaborate effectively with physicians.
• Ability to work independently.
• Effective communication skills, both written and verbal, with the ability to influence at all organizational levels.
• Proficiency with PC and familiarity with software including spreadsheets and presentation tools.
• Ability to travel, including overnight stays.

This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state.

#LI-Remote

#LI-MW2

Additional Information

Referral Process: If you are being referred by a current employee, ask your connection at HCSC 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, paid holidays, tuition reimbursement, and more. Details are available at https://careers.hcsc.com/totalrewards. Compensation varies based on skills and experience and may include an annual incentive bonus.

Equal Opportunity Employment

We are committed to diversity and inclusion. All qualified applicants will receive consideration without regard to 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