Clinical Practice Consultant - Remote in Southwest Idaho and surrounding areas

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 people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing together. The Clinical Practice Consultant (CPC) will be responsible for strategically developing clinically oriented provider and community-based partnerships, education, and action plans to increase quality scores based on HEDIS, NCQA, and state specific quality measures. This role will be responsible for ongoing management of provider practice quality measures. Through HEDIS documentation collection and review, monitoring, measuring, and reporting on key metrics, the Clinical Practice Consultant assists providers in meeting quality standards, state contractual requirements and pay for performance initiatives. If you reside in Idaho, you will have the flexibility to work remotely* as you take on this challenging and rewarding work. Primary Responsibilities: ? Ongoing management of provider practice and community education on HEDIS, NCQA, and state specific quality measures ? Work with provider practices to reputed company action plans to drive quality improvement ? Educate providers and office staff on proper clinical documentation, coding, and billing practices, CMS mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria, to drive quality improvement ? Analysis, review, and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements, and pay for performance initiatives ? Serve as subject matter expert (SME) for assigned Medicaid/Medicare HEDIS / CMS measures, preventive health topics; reputed company efforts with clinical team to research and design educational materials for use in practitioner offices; serve as liaison with key vendors supporting Medicaid/Medicare HEDIS / CMS Measures; consult with vendors to design and implement initiatives to innovate and then improve Medicaid/Medicare HEDIS / CMS Measure rates ? Identify patient care opportunities and collaborate with physician practices to ensure appropriate member appointments and care ? Coordinate and reputed company onsite clinical evaluations through medical record audits to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards ? Investigate gaps in clinical documentation where system variation has impact on reputed company calculation, provides feedback to appropriate team members where issues are verified, and monitors resolution to conclusion ? Document and refer providers' non-clinical / service issues to the appropriate internal parties, to include Provider Relations and the Plan Chief Medical Officer by analyzing provider records and maintaining database ? Other duties as assigned 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: ? 3+ years of Clinical experience in a physician practice, outpatient facility or a FQHC ? 2+ years of quality improvement experience ? 2+ years of Medicare / Medicaid experience ? Proficiency in software applications that include, but are not limited to, reputed company Word, reputed company reputed company, reputed company PowerPoint ? Reliable transportation to travel to physician offices locally up to 75% of the time ? reputed company of Idaho Preferred Qualifications: ? reputed company, unrestricted RN license in the State of ID ? 2+ years of HEDIS experience ? Health insurance industry experience, including regulatory and compliance ? Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, governing and regulatory agency requirements and the managed care industry ? reputed company employees 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 color, 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 enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply Job!