Description
RN Provider Clinical Liaison – NC Medicaid – Region 4 (JR7522)
Location: This position is remote. Qualified candidates must reside in North Carolina in the geographic area supported for commuting purposes. This role will oversee providers in Region 4 which includes Wake, Wilson, Johnson, Durham, and surrounding counties.
The Provider Clinical Liaison for North Carolina Medicaid (Region 4) supports primary care groups in Advanced Medical Home population health activities. This position serves a key role in Healthy Blue’s geographically organized provider support. The Clinical Liaison is responsible for managing quality and medical expense goal metrics for primary care groups by assisting in connecting high risk members and those having HEDIS gaps to their medical homes, to establish care plans that improve health outcomes.
Primary duties include:
- Use Healthy Blue databases and tools, including risk adjustment tools to identify opportunities for improvement in quality and costs for members in assigned practices
- Develop an operational plan for each medical practice to deploy office personnel and coordinate with Healthy Blue resources to optimize performance on targeted quality measures and to improve clinical and cost outcomes for members identified to have high clinical risk
- Coordinate scheduling of high-risk members and those having HEDIS gaps for appointments
- Communicate with medical office personnel about identified gaps in care that will be apparent to the practitioner at the patient encounter
- Meet with physicians and other clinical personnel to problem solve and develop engagement plans for high-risk members
- Work with practitioners and office staff to improve documentation of diagnoses, including specific manifestations, facilitate access of members to Healthy Blue case management, population health, and behavioral health programs as indicated, and help coordinate services provided by practice and Healthy Blue personnel
- Serve as the subject matter expert for primary care practices on all Healthy Blue clinically focused program
- Conduct periodic meetings with each practice to track progress towards implementing the project plan and attaining goals established in the engagement contract
- Support the Healthy Blue Provider Collaboration Lead in organizing and implementing support to achieve targeted revenue, medical expense, and quality goals for the assigned region
- Assures compliance to practice guideline, delegation and continuity and coordination of care standards
- Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of results.
Minimum Requirements:
- BA/BS in Nursing and minimum of 5 years of medical management experience; or any combination of education and experience, which would provide an equivalent background.
- Current unrestricted RN license in the state of North Carolina required.
- Must reside in the geographic area you will be supporting.
- Minimum 5 years of clinical experience.
- This position requires field work, visiting providers, as needed, up to 75% of the time.
Preferred Qualifications:
- Experience with clinical data analytics / risk adjustment tools.
- Advanced Excel skills + Word and Outlook.
- Tableau a plus!
- MS or advanced degree preferred.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealthinc.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.