What are the responsibilities and job description for the Clinical Nurse Liaison position at Louisiana Healthcare Connections?
Job Summary:
You have the opportunity to make a meaningful impact on the lives of our 28 million members as a clinical professional on our Medical Management/Health Services team.
This is a hybrid role seeking an LPN or RN that will serve as a liaison in the Baton Rouge and New Orleans areas, focusing on provider outreach. The position involves three days of in-field visits to facilities and two days of remote work dedicated to documentation and outreach.
The primary objective of this role is to drive provider performance improvement in key areas, including Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost, and utilization. This entails evaluating provider performance, developing strategic plans to enhance performance, and performing detailed HBR analyses.
In addition to these responsibilities, the successful candidate will facilitate provider trainings, orientations, and coaching for performance improvement within the network, while also assisting with claim resolution.
- Implement and manage procedures for tracking, identifying, and resolving operational issues
- Present program results and develop data-driven analysis and metrics to measure effectiveness and ROI of current and new products
- Represent the clinical perspective in various meetings
- Collaborate with staff to identify opportunities and initiate process changes to increase quality and improve staff, provider, and member satisfaction
- Serve as a resource and liaison on utilization, quality improvement, and case management activities
- Partner with staff and departments for provider education and outreach
- Collaborate with regional leadership for providers requiring a clinical interpretation of results related to health plan reporting, data, and quality incentive payments
- Support community and member initiatives with a focus on at-risk targets
- Split duties between fieldwork and remote administrative tasks
Requirements:
A minimum of four years of clinical nursing experience, preferably in a large primary care office or clinic setting working with Medicaid or the uninsured. Experience in conflict management, data reporting, or evaluation is also beneficial. Managed care, utilization management, case management, or quality improvement experience is preferred but not required.
