Clinical Quality Improvement Nurse Consultant

Assist BCBSKS contracting providers with clinical insight and coordination of care with the internal Value Based Programs Design Team, CMS programs, Disease Management, Case Management, Health Analytics, Pharmacy, and numerous internal department areas to assure successful program performance of better quality, better health, better care, and lower cost outcomes. Accountable for supporting the provider offices including contracting, provider reconciliation, implementing data/tools/processes to manage member populations for care coordination, assist to develop/maintain/communicate internal and external policies and procedures, and discussing quality outcomes. Innovation to increase member involvement, compliance and self-care responsibility is desired.

The Nurse Consultant develops and conducts clinic conference calls/webinars for sharing best practices across participants. The position is responsible for researching and responding to requests for information regarding HEDIS quality metrics and coordinating patient centered care. The Nurse Consultant will assist in promoting clinical quality improvement initiatives to Physician Liaison Committees, internal departments, and national/local employer groups through developing marketing materials and by suggesting member contract changes. This position provides clinical support to BCBSKS accountable care and health risk assessment programs.

“This position offers the flexibility to work either onsite, hybrid or remotely in accordance with our Telecommuting Policy. Candidates should be available to attend community events and onsite meetings as required. Applicants must currently reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
• Trust: Work for one of the most trusted companies in Kansas
• Stability: 80 years of commitment, compassion and community
• Flexibility: options to work onsite, remote or hybrid available
• Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

• Works with the Administrative Quality Committee (AQC) to conduct medical record reviews on all concerns and complaints regarding contracting provider/facility care to members. Prepares AQC quarterly and annual reports.
• Acts as the Peer Review Officer for AQC, conducts meetings on a monthly basis or more frequently if required by the AQC or case load, and works with external peer review organizations. Maintains and verifies the accuracy of the case log for the AQC.
• Must follow URAC standards as required for essential job functions.
• Performs duties in conjunction with management to collaborate and coordinate Clinical Quality Improvement activities between numerous internal departments, and providers and clinic staff to improve individual member health as well as population health.
• Leads clinical communications and correspondence as needed to implement the clinical quality improvement concepts in provider offices including training of vendor computer system, implementing data/tools/processes to manage member populations for care coordination, supporting development of internal and external policies and procedures, and developing program outcomes. Prepares quarterly and annual quality reports.
• Works closely with team members of various departments to determine and implement the most efficient and effective processes that result in positive health outcomes for members.
• Serves as a direct resource for development of care coordination solutions for BCBSKS staff, providers, employer groups, members, liaison committees, advisory committees, and related programs required by the Association.
• Assist and support quality management programs that promote measurement, monitoring and evaluation of services and work processes to improve the quality based activities and outcomes.
• Capable of remaining in stationary position (chair) for long periods of time during the workday.
• Collaborates with team members of various departments to identify trends and coordinate provider/member education regarding quality measurement and reporting.

• Masters, Baccalaureate, Diploma or Associate Degree in Nursing;
• Current unrestricted Kansas RN licensure

• Minimum of 5 years of RN clinical experience to include 3 years’ experience working on clinical quality improvement activities to improve HEDIS measures is required.
• Must be Certified Professional Coder (CPC) by American Academy of Procedural Coders within two years of hire.

• Ability to communicate effectively, verbally, in writing and via telephone with providers, internal staff, and external entities.
• Ability to self-direct, make independent decisions, prioritizes daily activities.
• Ability to solve problems independently or with minimal supervision.
• Ability to be flexible and adapt to change in timely manner.
• Awareness and understanding of current provider medical and utilization practices.
• Responsible for maintaining an awareness and understanding of the business unit recovery plan for the department you work in and the corporation’s business continuity program in general.

• Base pay is only one component of your competitive Total Rewards package
• Incentive pay program (EPIP)
• Health/Vision/Dental insurance
• 6 weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks paid caregiver leave
• 5% 401(k) plan matching
• Tuition reimbursement
• Health & fitness benefits, discounts and resources