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Job Summary

This position is a field-based quality role responsible for supporting HCSC's quality imperatives, value-based care models, and provider 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 staff to improve key targeted HEDIS measures. This position involves model and program development, clinical readiness assessments, entity- and network-management-led joint operating committees, obtaining EMR access, implementing provider-based member outreach initiatives and provider supplemental data submissions, and retrieving key medical records throughout the year. The role provides ongoing and annual evaluation of the effectiveness of the overall quality improvement program for the assigned line of business. It is also responsible for creating and maintaining strong working relationships with the care coordination and care management teams at the value-based entity, as well as with local Network Management and internal Clinical Operations teams, providing consultative support and ensuring 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 includes overnight stays.

Preferred Job Qualifications

• Currently resides in Florida, Georgia, Alabama, Mississippi, South Carolina, North Carolina, New Mexico, Pennsylvania, Delaware, New York, New Jersey, or Connecticut.
• Ability to commit to local travel 20% or less to engage with various hospital systems.
• Demonstrated success improving HEDIS, STAR, quality, or performance metrics through provider engagement and operational improvements.
• Experience supporting population health or value-based care initiatives within a health plan, medical group, or healthcare system.
• Experience analyzing clinical and operational performance data to identify opportunities for quality improvement.
• Proven ability to build trusted relationships and influence clinical and operational stakeholders.
• Experience leading practice transformation, workflow improvement, or quality performance initiatives.

This is a fully remote position, available in the US only, not limited to the posting location.

Sponsorship is not available.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

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.

Base Pay Range

$70,600.00 - $149,600.00

Exact compensation may vary based on skills, experience, and location.

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About HCSC

For more than 80 years, HCSC has been dedicated to expanding access to high-quality, cost-effective health care and equipping our members with information and tools to make the best health care decisions for themselves and their families. As an industry leader, HCSC also has been helping to make the health care system work better for all Americans. To remain a leader, we offer compelling careers that encourage resourcefulness, strategic thought and empower you to make a difference in the lives of our members and their communities.

Today, with the industry at an important crossroad, HCSC is reimagining health care and looking for original thinkers who aren’t afraid to make innovative contributions. We are an Equal Opportunity Employment employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Learn more about HCSC, our commitment to our members and the opportunity you’ll have to improve health care delivery in an open, collaborative environment.

HCSC is committed to diversity in the workplace and to providing equal opportunity to employees and applicants.

If you are an individual with a disability or a disabled veteran and need an accommodation or assistance in either using the Careers website or completing the application process, you can call us at 1-866-977-7378 to request reasonable accommodations.

Please note that only requests for accommodations in the application process will be returned. All applications, including resumes, must be submitted through HCSC's Career website on-line application process. If you have general questions regarding the status of an existing application, navigate to "candidate home" to view your job submissions.

Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Oklahoma, and Blue Cross and Blue Shield of Texas,
Divisions of Health Care Service Corporation, a Mutual Legal Reserve Company, and Independent Licensee of the Blue Cross and Blue Shield Association

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