Clinical Consultant

The Clinical Consultant works closely with leadership, leads cross-divisional teams, and partners with Quality Managers at Blue Cross healthcare provider sites to achieve excellent clinical quality performance. The position will focus on developing collaborative relationships with provider clinics to drive process improvements and achieve desired outcomes within tight deadlines. The Clinical Consultant will ensure accurate clinical performance measurement reporting, based on ongoing data collection via electronic medical records, analysis, concurrent evaluation of the data, and continuous feedback and consulting based on progress.

• Develop and manage cross-functional planning and implement new, expanded, or improved clinical quality improvement initiatives.

• Initiatives may involve several partners and often require collaboration with external entities.

• Establish and maintain relationships with Blue Cross Network Healthcare Providers. This includes education and coaching of providers and clinic staff on quality guidelines, measurements, and Blue Cross network protocols to assure optimal healthcare delivery and outcomes for our members.

• Provide guidance to multiple clinics and departments, research and respond to provider inquiries related to best practice guidelines, and serve as a subject matter expert during implementation of recommended improvement strategies.

• Evaluate provider performance on industry standard clinical quality measures via on-going assessment of medical records documentation and by facilitating discussions with quality improvement managers at provider clinics. This includes tracking, trending and accurately documenting medical record findings to provide detailed information to assist clinics with improvement initiatives.

• Evaluate effectiveness of clinical health improvement practices in order to provide strategic health improvement recommendations that shape future health improvement efforts.

• Support the (Health Effectiveness Data and Information Set) HEDIS Medical Records Review process, including performing chart reviews and over reads to establish HEDIS performance rates.

• Coach, mentor, and serve as subject matter expert resource to HEDIS Medical Records Abstractors.

• Assist leadership with abstractor quality monitoring and oversight as needed.

• Participates in the coaching, mentoring, and training of employees and/or contract staff.

• Perform other accountabilities as assigned.

• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.

• Experience to include work in a clinical setting.

• Excellent critical analysis skills.

• Detail orientation, with the ability to compare clinical practices against standards and best practices, evaluating compliance, recommending improvement strategies, and producing accurate documentation.

• Demonstrated ability to work independently and make decisions as needed, must possess a proven track record of achievement.

• Organized and able to manage several priorities against challenging deadlines.

• Excellent continuous quality improvement and/or project management skills.

• Creative problem solving skills, ability to adapt approach as needed.

• Ability to develop strong cross-functional and collaborative relationships with internal and external partners, including the ability to work with a wide variety of people and personalities.

• Articulate communicator with excellent verbal and written communication skills.

• High school diploma (or equivalency) and legal authorization to work in the U.S.

• Bachelor's degree.

• Active License to practice nursing in the state of Minnesota.

• Masters degree in business, nursing, public health, health sciences, health promotion or related field.

• Medical Coding education and/or experience CPH certification or equivalent healthcare quality or compliance certification.

• Current experience with Electronic Medical Records navigation

Compensation and Benefits:

Pay Range: $77,200.00 - $102,300.00 - $127,400.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

To discover more about what we have to offer, please review our benefits page.

Role Designation

Hybrid

Anchored in Connection

Our hybrid approach is designed to balance flexibility with meaningful in-person connection and collaboration. We come together in the office two days each week - most teams designate at least one anchor day to ensure team interaction. These in-person moments foster relationships, creativity, and alignment. The rest of the week you are empowered to work remote.