Clinical Practice Consultant

Blue Cross Blue Shield of IL, MT, NM, OK & TX - Albuquerque, NM (9 months ago)

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Job Purpose:
This position is a field-based quality position, responsible for supporting HCSC;s quality imperatives and value-based care models and 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 and other staff to improve key targeted HEDIS measures. This position participates in model/program development, clinical readiness assessments of entity and Network Management led joint operating committees, obtaining EMR access, implementing provider-based member outreach initiatives and provider supplemental data submissions, and retrieval of key medical records throughout the year. This role provides ongoing and annual evaluation of the effectiveness of the overall Quality Improvement Program for the line of business assigned and is also responsible for creating and maintaining strong working relationships with the care coordination/care management teams at the value based entity and internally with local Network Management and internal Clinical Operations teams to provide consultative support and ensure day to day operational needs are being met.

Required Job Qualifications:
  • Registered Nurse (RN) OR Physicians 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 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 including overnight stays.
  • CA
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Expertise Nursing
Job Type Full-Time Regular
Location NM - Albuquerque
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants.

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