Remote Clinical Quality Improvement 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

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.