Clinical Practice Consultant

Health Care Service Corporation

. Support HCSC's quality imperatives, value-based care models, and provider relationships .

Posted 9/29/2026full-timeRemote • United StatesMid-LevelSenior💰 $76,600 - $138,500 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in quality improvement initiatives, HEDIS measures, and value-based care models while effectively collaborating with healthcare providers and stakeholders. Proficient in clinical program design and operational performance analysis to enhance healthcare delivery.

Highest-signal resume keywords

Registered Nurse (RN) LicenseHEDIS ImprovementClinical Program DesignEffective Communication SkillsPopulation Health Initiatives

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Readiness AssessmentQuality Improvement Program EvaluationData Analysis for Quality ImprovementProvider EngagementPresentation Skills

Soft Skills

Collaborative WorkIndependent WorkRelationship BuildingInfluencing Skills

Tools & Technologies

EMR AccessPC SkillsSpreadsheet SoftwarePresentation Software

Certifications & Qualifications

Registered Nurse (RN)Physician's AssistantNurse Practitioner

Industry Keywords

Health InsuranceManaged CareAccreditation StandardsValue-Based CareQuality Metrics

About the role

Key responsibilities & impact

Support HCSC's quality imperatives, value-based care models, and provider relationships
Collaboratively work with assigned medical practices or individual PCPs, the appropriate Medical Director and Clinic Directors, and medical and non-medical quality staff
Improve key targeted HEDIS measures
Participate in model and program development
Conduct clinical readiness assessments
Support entity- and network-management-led joint operating committees
Obtain EMR access
Implement provider-based member outreach initiatives and provider supplemental data submissions
Retrieve key medical records throughout the year
Provide ongoing and annual evaluation of the effectiveness of the overall quality improvement program for the assigned line of business
Create and maintain strong working relationships with care coordination and care management teams at the value-based entity, local Network Management, and internal Clinical Operations teams
Provide consultative support and ensure operational needs are being met
Travel, including overnight stays

Requirements

What you’ll need

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
Sponsorship is not available
Preferred: Currently resides in Florida, Georgia, Alabama, Mississippi, South Carolina, North Carolina, New Mexico, Pennsylvania, Delaware, New York, New Jersey, or Connecticut
Preferred: Ability to commit to local travel 20% or less to engage with various hospital systems
Preferred: Demonstrated success improving HEDIS, STAR, quality, or performance metrics through provider engagement and operational improvements
Preferred: Experience supporting population health or value-based care initiatives within a health plan, medical group, or healthcare system
Preferred: Experience analyzing clinical and operational performance data to identify opportunities for quality improvement
Preferred: Proven ability to build trusted relationships and influence clinical and operational stakeholders
Preferred: Experience leading practice transformation, workflow improvement, or quality performance initiatives

Benefits

Comp & perks

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
Other incentives
Annual incentive bonus plan