Clinical Value Consultant
At HCSC, building a talent engine for the future is a key priority because we recognize that as our business evolves to reflect the changing world, we must adapt our workforce to meet this challenge. Additionally, with "excellence" one of our core values, we are focused on improving our success measures and delivering the best possible customer experience.
This position can be based out of our Naperville, IL or Downers Grove, IL office.
This position is responsible for supporting HCSC's value-based care models and relationships through participation in model/program development, clinical readiness assessments of entity and Network Management led joint operating committees. The role is also responsible for creating and maintaining strong working relationships with the care coordination/care management teams at the value based entity and internally with local Network Management and internal Clinical Operations teams to provide consultative support and ensure day to day operational needs are being met.
Required Job Qualifications:
•Current, unrestricted license in one of the following: Registered Nurse (RN), or Licensed Professional Counselor (LPC), Licensed Master Social Worker (LMSW).
•Bachelor's degree in a clinical field
•5 years of experience in managed care
•Experience designing clinical program(s)
•Knowledge of federal and accreditation standards and regulations for the health insurance industry (URAC, NCQA, ACA, State Departments of Insurance and/or comparable regulatory bodies)
•PC skills and familiarity with various software packages including spreadsheets and presentations.
•Effective communication and writing skills and ability to communicate and influence internal and external customers at all levels of the organization
•Analytical and root cause analysis skills
Preferred Job Qualifications:
•Ability and willingness to travel, including overnight stays
•Experience working with providers
•Experience with HEDIS
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Requirements: Expertise Quality Assurance, General Health Care, Government Programs, Nursing, Network Management / Provider Relations, Regulatory & Compliance Job Type Full-Time Regular Location IL - Downers Grove, IL - Naperville
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