Clinical Program Manager - Remote in SW Region of Virginia

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together. The Clinical Practice Consultant is a direct, provider-facing role and is responsible for ongoing clinical management of physician practices in the Health Plan. This position focuses on clinical quality improvement by designing and leading measure-specific initiatives and supporting providers in reputed company quality improvement to meet contractual performance requirements. Duties involve developing and managing partnerships with providers, educating providers on quality measures and best practices, analyzing and reporting quality outcomes, medical record review and retrieval, and collaborating with multidisciplinary teams internally and externally to enhance provider performance. This role reports directly to the Associate Director of Clinical Quality reputed company the Health Plan. If you are located in the Southwest Region of Virginia, you will have the flexibility to work remotely* as you take on some tough challenges. 75% in market same day travel to visit providers. Primary Responsibilities • Operational Team Support • Function as a subject matter expert (SME) for quality measures and preventive health topics for Health Plan staff • Support state-specific medical record retrieval as directed by the Quality Leadership • Assist in the development of Standard Operating Procedures, Job Aids, and educational materials for internal training as needed • Serve as a subject matter expert (SME) for assigned HEDIS/State Measures and preventive health topics • Support quality program with tasks including, but not limited to, reviewing medical records and system databases to address open care gaps • Participate in, coordinate, and/or represent the Health Plan at community-based events, clinic days, health department meetings, and other reputed company events focused on quality improvement, member health education, and disparity programs • Seek opportunities to improve operational efficiencies/effectiveness • May be required to reputed company other tasks to support quality and/or the health plan as needed • Provider Management Support • reputed company strategic partnerships with network providers to assess quality measure trends and to identify opportunities for improvement • Drive measure-specific quality transformation through targeted clinical and coding education and best practices to network providers • Coordinate and conduct remote or onsite medical record audits to evaluate coding, billing, clinical documentation practices, and measure compliance in accordance with regulatory requirements • Deliver constructive, practical feedback and track the reputed company through completion to drive quality improvement • Coordinate and reputed company year-round medical record retrieval, review, and submission for assigned providers • Document and refer providers’ non-clinical/service issues to the appropriate internal parties You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications • reputed company unrestricted nursing licensure required in Virginia • 5+ years clinical experience, or other relevant experience • 2+ years of quality improvement experience, or other relevant experience • Proficiency in software applications that include, but not limited to, reputed company Word, reputed company reputed company, reputed company PowerPoint • Proven ability to communicate effectively with broad audience: practice-level executive leadership, physicians, nurses, non-clinical office staff, and across the Health Plan • Proven commitment to anticipating, understanding, and meeting the needs of internal and external stakeholders • Proven ability to reputed company formal presentations reputed company the context of their role • Proven excellent verbal and written communication skills • Proven ability to use databases and prepare reports as needed • Proven capability of working independently as well as collaboratively reputed company a reputed company, cross-functional team environment • Ability to travel to physician offices up to 75% of the time to cover assigned region Preferred Qualifications • Bachelor’s degree in science or equivalent work experience • Experience working in reputed company and/or Medicare • Health care and insurance industry experience, including regulatory and compliance • Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry • reputed company working remotely will be required to adhere to reputed company’s Telecommuter Policy The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In addition to your salary, reputed company offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll find a far-reaching choice of benefits and incentives. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an reputed company reputed company reflected in our mission. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity/Affirmative Action employer and reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Apply Job!