Offer summary

Qualifications:

Registered Nurse (RN), Physician's Assistant, or Nurse Practitioner with an unrestricted license in the state of operations., 4 years of experience in health insurance, managed care, or medical group insurance., Knowledge of federal and accreditation standards for the health insurance industry., Effective communication skills and ability to work collaboratively with physicians..

Key responsibilities:

Support HCSC’s quality imperatives and value-based care models by working with medical practices and PCPs.

Participate in clinical readiness assessments and implement provider-based member outreach initiatives.

Evaluate the effectiveness of the Quality Improvement Program and maintain relationships with care coordination teams.

Conduct presentations for member and provider training and ensure operational needs are met.

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

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 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.
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.

This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state.

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.