🚀 Clinical Practice Consultant

Position Overview

This position is a field-based quality role responsible for supporting HCSC's quality imperatives and value-based care models. It involves collaborating with assigned medical practices or individual PCPS, medical directors, clinic directors, and all medical and non-medical staff to improve key targeted HEDIS measures.

The role includes participating in model/program development, clinical readiness assessments, joint operating committees, obtaining EMR access, implementing provider-based outreach initiatives, and managing provider data submissions and medical record retrieval throughout the year.

Additionally, this position provides ongoing evaluation of the effectiveness of the quality improvement program for the assigned line of business. It is responsible for building strong relationships with care coordination teams, internal network management, and clinical operations to support day-to-day operational needs.

Job Requirements

• License: Registered Nurse (RN), Physician's Assistant, or Nurse Practitioner with a current, unrestricted license in the state of operation.
• Experience: At least 4 years in health insurance, managed care, or medical group experience. Knowledge of federal and accreditation standards for the health insurance industry.
• Skills: Experience in designing clinical programs and conducting member/provider training presentations.
• Collaboration: Proven ability to work collaboratively with physicians.
• Independence: Ability to work independently.
• Communication: Effective written and verbal communication skills, with the ability to influence at all organizational levels.
• Technical Skills: Proficiency with PC and familiarity with software packages including spreadsheets and presentations.
• Travel: Ability to travel, including overnight stays.