Clinical Practice Consultant Resume Samples

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L Dicki

Luigi

Dicki

203 Bosco Circle

Dallas

+1 (555) 413 8123

203 Bosco Circle

Dallas

Phone

p +1 (555) 413 8123

Experience Experience

San Francisco, CA

Clinical Practice Consultant

San Francisco, CA

Yundt-O'Connell

San Francisco, CA

Clinical Practice Consultant

Educates providers and office staff on proper clinical documentation, coding, and billing practices, CMS mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria, to drive quality improvement
Serves as subject matter expert (SME) for assigned HEDIS / State Measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting HEDIS / State Measures; consults with vendors to design and implement initiatives to innovate and then improve HEDIS / State Measure rates
Helps practice meet and exceed expectations / milestones for achieving success
Monitors monthly and quarterly performance reports of assigned practices
Analyzes key cost, utilization and quality data and interprets results to assess the performance of the practice
Based from performance analysis, develops strategies for improvement that includes specific outcomes and metrics to monitor progress to a goal; provides feedback and makes recommendations for improvement
Serve as a single point of contact to assigned practices for program and operational issues

Philadelphia, PA

Hedis Clinical Practice Consultant

Philadelphia, PA

Littel-Gottlieb

Philadelphia, PA

Hedis Clinical Practice Consultant

Supports effective deployment of program at the practice level through strategic partnerships with participating practitioners and practice staff while assessing trends in quality measures and identifying opportunities for quality improvement
Designs practice level quality transformation through targeted clinical education and approved materials related to HEDIS / State Specific quality measures for provider and staff education during field visits
Participates, coordinates, and / or represents the Health Plan at community based organization events, clinic days, health department meetings and other outreach events focused on quality improvement, member health education, and disparity programs as assigned
Identifies population - based member barriers to care and works with the QMP team to identify local level strategies to overcome barriers and close clinical gaps in care
Reports individual member quality of care concerns or trends of concern to the Health Plan Quality Director
Educates providers and office staff on proper clinical documentation, coding and billing practices, state - mandated quality metrics specifications, provider profiling and pay for performance measurement and medical record review criteria
Participates, coordinates and / or represents the Health Plan at community based organization events, clinic days, health department meetings and other outreach events focused on quality improvement, member health education and disparity programs as assigned

present

Phoenix, AZ

Senior Clinical Practice Consultant

Phoenix, AZ

O'Kon, Kilback and Schmitt

present

Phoenix, AZ

Senior Clinical Practice Consultant

present

Monitors monthly and quarterly performance of assigned practices
Analyzes key cost, utilization and quality data and interprets results to assess the performance of the practice; identifies strategies for improvement to include specific outcomes and metrics to monitor progress to a goal; provides feedback and makes recommendations for improvement
Reviews Clinical Action report results to guide practice in identifying care management opportunities and adjust processes to prioritize interventions to achieve clinical and cost outcomes
Utilizing the results of the practice performance analysis and input from the practice, develops/updates performance improvement action plans; monitors practice efforts to address performance and care management opportunities
Serves as a single point of contact to practices for program and operational issues
Establish and maintain a supportive, collegial role with assigned ACO and PCMH practices
Facilitates efficient, effective practice improvement meetings

Education Education

Master’s Degree in Health Related Field Required

University of Cincinnati

Master’s Degree in Health Related Field Required

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Senior Clinical Practice Consultant Resume Examples & Samples

Accountable for successful deployment of program at the practice level, including, attribution, provider rosters and performance and clinical reporting; introduces and educates practice on the value/use of reporting tools and delivery of reports via Physician Portal; provides assistance with HIT, EMR, disease registries and other technology
Consults with and guides practice on developing innovative solutions to practice organization and structural challenges in order to achieve desired program outcomes. Brings best practice experience and connects practices with other high performing practices to spur innovation. Helps practice meet and exceed expectations/milestones for achieving success as a PCMH or ACO
Monitors monthly and quarterly performance of assigned practices
Analyzes key cost, utilization and quality data and interprets results to assess the performance of the practice; identifies strategies for improvement to include specific outcomes and metrics to monitor progress to a goal; provides feedback and makes recommendations for improvement
Reviews Clinical Action report results to guide practice in identifying care management opportunities and adjust processes to prioritize interventions to achieve clinical and cost outcomes
Utilizing the results of the practice performance analysis and input from the practice, develops/updates performance improvement action plans; monitors practice efforts to address performance and care management opportunities
Works with the practice and OptumHealth to align and integrate OptumHealth care/disease management programs and population health services to augment the practice's capabilities, support their care management efforts and add value to the patient care experience
Serves as a single point of contact to practices for program and operational issues
Establish and maintain a supportive, collegial role with assigned ACO and PCMH practices
Effectively collaborates with HLM, PCMH and ACO team members including assigned PMOs, ECMs; CRS's, Medical Directors, local Network leads, HCE Analysts and Clinical Analysts in support of the program
Assists and supports HLM, PCMH and ACO leaders in summarizing and disseminating experience-related learning by way of team updates, written reports/articles, and/or presentations as called for by directors
BS/BA
Demonstrated experience in analyzing health care practice performance data and identifying opportunities for improvement and innovation
Excellent verbal, written, presentation, and group facilitation skills required, with the ability to convey complex or technical information in a manner that others can understand
Strong critical thinking skills necessary to evaluate and respond to practice challenges and related team dynamics
Superior interpersonal skills with the ability to build positive relationships with key practice representatives and team members across the enterprise
Health care quality improvement, practice management experience
5+ years of experience in either practice or medical management, health care analytics, managed care contracting or experience in a primary care or multi-specialty practice that has successfully implemented PCMH or ACO programs or quality improvement initiatives

Clinical Practice Consultant Resume Examples & Samples

Understanding and providing performance and clinical reporting, provide assistance with HIT, EMR, disease registries and other technology
Using results of practice readiness assessments and other collected information, design practice transformation action plans and implement appropriate performance improvement initiatives designed to assist the practice in achieving contractually required transformation milestones
Monitor and review the progress of the practice in milestone achievement and insure the practice is accountability for successful completion
Helps practice meet and exceed expectations / milestones for achieving success

Senior Clinical Practice Consultant Resume Examples & Samples

Accountable for successful deployment of program at the practice level, including, attribution, provider rosters and performance and clinical reporting; introduces and educates practice on the value / use of reporting tools and delivery of reports via Physician Portal; provides assistance with HIT, EMR, disease registries and other technology
Consults with and guides practice on developing innovative solutions to practice organization and structural challenges in order to achieve desired program outcomes. Brings best practice experience and connects practices with other high performing practices to spur innovation. Helps practice meet and exceed expectations / milestones for achieving success as a PCMH or ACO
Utilizing the results of the practice performance analysis and input from the practice, develops / updates performance improvement action plans; monitors practice efforts to address performance and care management opportunities
Works with the practice and OptumHealth to align and integrate OptumHealth care / disease management programs and population health services to augment the practice's capabilities, support their care management efforts and add value to the patient care experience
Assists and supports HLM, PCMH and ACO leaders in summarizing and disseminating experience-related learning by way of team updates, written reports / articles, and/or presentations as called for by directors
BS / BA

Senior Clinical Practice Consultant Resume Examples & Samples

Analyzes key cost, utilization and quality data and interprets results to assess the performance of the practice
Based from performance analysis, develops strategies for improvement that includes specific outcomes and metrics to monitor progress to a goal; provides feedback and makes recommendations for improvement
Demonstrated experience in analyzing health care practice performance data and identifying opportunities for improvement
5+ years of experience in at least one of the following: quality improvement, practice management, medical management, health care analytics, managed care contracting OR experience in a primary care or multi-specialty practice that has successfully implemented PCMH or ACO programs for quality improvement initiatives
Strong Microsoft Office Skills

Senior Clinical Practice Consultant Resume Examples & Samples

Designs practice level quality transformation through targeted clinical education and approved materials related to HEDIS/State Specific quality measures for provider and staff education during field visits. Materials additionally include information from local, state, and national departments of health on key health related issues (understanding, exploring, educating and facilitating on a local level)
Reports individual member quality of care concerns or trends of concern to the Health Plan Quality Director
Investigates gaps in clinical documentation where system variation has impact on rate calculation, provides
Feedback to appropriate team members where issues are verified, and monitors resolution to conclusion
Based on medical record audit findings, provides follow-up education, practitioner intervention, and measurement as needed to drive quality improvement
Educates providers and office staff on proper clinical documentation, coding, and billing practices, state-mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria
Supports continuum of member care by identifying members in need of health education and/or services (case management, etc.) and refers members to the appropriate internal departments per policy
If required, supports state specific medical record collection and abstraction processes to drive optimum measurement and quality metric reporting during ambulatory medical record review, HEDIS data collection, or for other focus studies as directed by the Plan Quality Director
Supports quality improvement program studies with work that ranges from accessing and analyzing provider records, maintaining databases, and researching to identify members' encounter history
Participates in or coordinates with other department projects as needed
Experience working in Medicaid and/or Medicare
Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements, and the managed care industry
Bachelor’s degree in Science or equivalent work experience required; Masters degree preferred

Clinical Practice Consultant Resume Examples & Samples

Supports efforts with clinical team to research and design educational materials and programs for members and in practitioner offices; serves as liaison with key vendors supporting HEDIS/State measures; coordinates with vendors to facilitate initiatives to improve HEDIS/State measure rates
Participates, coordinates, and/or represents the Health Plan at community based organization events, clinic days, health department meetings, and other outreach events focused on quality improvement, member health education, and disparity programs as assigned
Coordinates and performs onsite clinical evaluations through medical/treatment record audits to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards
Educates providers and office staff on proper clinical documentation, coding, and billing practices, state- mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria
Documents and refers providers’ non-clinical/service issues to the appropriate internal parties, to include Provider Relations and the Plan Chief Medical Officer
If required, supports state specific medical/treatment record collection and abstraction processes to drive optimum measurement and quality metric reporting during ambulatory medical record review, HEDIS data collection, or for other focus studies as directed by the Plan Quality Vice President
Needs to works independently and within an integrated team in a highly matrixed environment
3+ years’ service delivery system or managed care setting experience
Experience working in Medicaid and/or Medicare in the Managed Care setting
Role requires travel to physician offices locally up to 50% of their time
Role requires contacting members in an effort to close identified gaps in care
Bachelor’s degree in healthcare or related field

Hedis Clinical Practice Consultant Resume Examples & Samples

Materials additionally include information from local, state and national departments of health on key health related issues (understanding, exploring, educating and facilitating on a local level)
Participates, coordinates, and / or represents the Health Plan at community based organization events, clinic days, health department meetings and other outreach events focused on quality improvement, member health education, and disparity programs as assigned
Based on medical record audit findings, provides follow - up education, practitioner intervention and measurement as needed to drive quality improvement
Educates providers and office staff on proper clinical documentation, coding and billing practices, state - mandated quality metrics specifications, provider profiling and pay for performance measurement and medical record review criteria
Works with providers on standards of care and advises providers on established clinical practice guidelines, and appropriate documentation and billing consistent with state specific measures and technical specifications
Current, unrestricted RN license in the state of NJ
2+ years of HEDIS and / or STARS experience
Managed Medicaid and / or Medicare experience
Managed care industry

Senior Clinical Practice Consultant Infusion Resume Examples & Samples

Tier 3 escalation and response to customer sites to assist when infusion product issues have been identified and escalated through Customer Advocacy and/or the product monitoring process. Provide monitoring, assist in identifying the root cause, and develop action plans as directed to mitigate issue re-occurrence
Provide input into development/revisions of customer education material, assessment tools and reporting documents
Work with internal teams to establish/schedule support for training and related activities
Facilitate projects by using established project planning process and develops RACI model to achieve optimal outcome
Coordinate communication flow throughout team and customer. Manage timelines, costs, resources and reports status and progress to project plan to management through reports
Other duties as assigned or as required
Must be able to interface at all levels of the organization within and outside of the Company, so strong relationship building and interpersonal skills are required
Must have strong communications and project management abilities, and excellent computer and technology skills
Must be able to coordinate and drive execution plans of highly skilled and professional matrixed multidisciplinary teams that are internal and external to the organization to ensure a timely and seamless customer experience
Ability to travel extensively is required. Overnight travel, off shifts, and weekend shifts required
Must have demonstrated project and team management experience in field setting
LI-AB1

Clinical Practice Consultant Resume Examples & Samples

Visit providers’ offices to educate them on clinical measures
Provide providers with list of gaps in member services / screenings
Work directly with members to educate them about managing their healthcare
Perform chart reviews for HEDIS
Assist with performance improvement projects
RN in state of Georgia
3+ years clinical nursing experience, preferably in managed care environment
Experience presenting to others
Access to high speed Internet
Ability to create spreadsheets in Excel
Experience working with providers’ offices
Comfort with reading reports and analyzing data

Senior Clinical Practice Consultant Resume Examples & Samples

Designs practice level quality transformation through targeted clinical education and approved materials related to HEDIS / State Specific quality measures for provider and staff education during field visits. Materials additionally include information from local, state, and national departments of health on key health related issues (understanding, exploring, educating and facilitating on a local level)
Serves as subject matter expert (SME) for assigned HEDIS / State Measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting HEDIS / State Measures; consults with vendors to design and implement initiatives to innovate and then improve HEDIS / State Measure rates
Identifies population - based member barriers to care and works with the QMP team to identify local level strategies to overcome barriers and close clinical gaps in care
Experience working in Medicaid and / or Medicare

Clinical Practice Consultant Resume Examples & Samples

Responsible for strategically developing clinically oriented provider and community based relationships in order to increase quality scores based on state specific quality measures
Responsible for collaborating with provider practices and the community to provide education on state specific quality measures
Provider education regarding the quality improvement program involves analysis and review of quality outcomes at the provider level, monitoring, measuring and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements and pay for performance initiatives
Conducts chart audits which occur in accordance with State, CMS or other requirements as applicable
Responsible for direction and guidance on provider-focused clinical quality improvement and management programs
Assists contracted providers with analyzing member care, trending quality compliance at the provider level and developing action plans and programs to support provider practices in continuous quality improvement using approved clinical practice guidelines, HEDIS, CMS, NCQA and other tools
Reports to the Quality Leadership of the Health Plan
Current unrestricted RN licensure required in the state of FL
5+ years clinical experience
2+ years of quality improvement experience
Experience working in Medicaid
Knowledge of the following: HEDIS, clinical standards of care, preventive health standards, NCQA, governing and regulatory agency requirements and the managed care industry
Knowledge in Pediatric and Adult HEDIS Measures with an emphasis on Pediatrics
PC experience including Microsoft Office Suites with a proven track record of working with data, analysis and excel (pivot tables)
Project Management and ability to successfully lead teams toward successful project completion
Role requires travel to physician offices locally up to 25% of their time
BSN or Master’s Degree in Nursing, Public Health or Health Administration
Prior Case Management

Hedis Clinical Practice Consultant Resume Examples & Samples

Serves as subject matter expert (SME) for assigned HEDIS / CMS measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting HEDIS / CMS Measures; consults with vendors to design and implement initiatives to innovate and then improve HEDIS / CMS Measure rates
Current, unrestricted RN / LPN license in the state of NJ or Foreign Medical Graduate
3+ years clinical experience in a physician practice, outpatient facility or FQHC
Basic proficiency in Microsoft Excel
2 years of HEDIS experience

Senior Clinical Practice Consultant Resume Examples & Samples

*Candidate must live in Yuma as this is a telecommuter position working with providers in these areas***
Based on medical record audit findings, provides follow - up education, practitioner intervention, and measurement as needed to drive quality improvement
Educates providers and office staff on proper clinical documentation, coding, and billing practices, state - mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria
Documents and refers providers’ non - clinical / service issues to the appropriate internal parties, to include Provider Relations and the Plan Chief Medical Officer
Needs to works independently and within an integrated team in a highly matrix environment

Clinical Practice Consultant Resume Examples & Samples

Introduces and educates practice on the value/use of reporting tools and delivery of reports via online portal; provides assistance with HIT, EMR, disease registries and other technology
Using results of practice readiness assessment, designs practice transformation plan and implements appropriate training modules designed to assist practice in achieving contractually required transformation milestones
Monitors monthly and quarterly performance of assigned practices. Analyzes key cost, utilization and quality data and interprets results to assess the performance of the practice; identifies strategies for improvement to include specific outcomes and metrics to monitor progress to a goal; provides feedback and makes recommendations for improvement
BS/BA required
At least 2 years of experience in quality and performance improvement in a primary care or multi-specialty practice, including medical management, healthcare analytics, and/or managed care contracting in a PCMH or ACO setting
Clinical background preferred
Position requires flexibility to work remotely with travel to practice locations as needed with the ability to meet multiple deadlines and handle interruptions to on-going work activities

Senior Clinical Practice Consultant Resume Examples & Samples

Serves as subject matter expert (SME) for assigned Medicare HEDIS/ CMS measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting Medicare HEDIS/CMS Measures; consults with vendors to design and implement initiatives to innovate and then improve Medicare HEDIS/CMS Measure rates
Identify patient care opportunities and collaborate with physician practices to ensure appropriate member appointments and care
Investigates gaps in clinical documentation where system variation has impact on rate calculation, provides feedback to appropriate team members where issues are verified, and monitors resolution to conclusion
RN, LPN, or Foreign Medical Graduate
3+ years clinical experience in a physician practice, outpatient facility, or a FQHC
2 years of Medicare experience
Intermediate level in software applications that include, but are not limited to, Microsoft Word and Microsoft Excel
Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, governing and regulatory agency requirements, and the managed care industry

Clinical Practice Consultant Resume Examples & Samples

Bachelors degree in Science
Current unrestricted RN licensure required in the state of operation
Travel to physician offices locally up to 75% of their time
Masters degree

Clinical Practice Consultant Resume Examples & Samples

Provides leadership and expert consultation on the design, development, and implementation of programs related to the expertise area
Leads a group of consultants, analysts and/or staff focused on the delivery of service/products within the responsible technical area(s)
Provides leadership and direction for the technical area(s) in accordance with the overall strategic direction of the group
Serves as the content expert of the responsible technical area(s) and provides technical assistance and advice

Clinical Practice Consultant Resume Examples & Samples

Assist in successful deployment of program at the practice level, including, attribution, provider rosters and performance and clinical reporting; introduces and educates practice on the value/use of reporting tools and delivery of reports via Physician Portal; provides assistance with HIT, EMR, disease registries and other technology
Using results of practice readiness assessment, designs practice transformation plan and implements appropriate training modules designed to assist practice in achieving contractually required transformation milestones; monitors progress of practice in milestone achievement and insures practice accountability for successful completion
Utilizing the results of the practice performance analysis and input from the practice, develop/update performance improvement action plans; monitor practice efforts to address performance and care management opportunities
Works with the practice and OptumHealth to align and integrate OptumHealth care/disease management programs and population health services to augment the practice’s capabilities, support their care management efforts and add value to the patient care experience
Establishes and maintains a supportive, collegial role with assigned PCMH practices
Facilitates efficient, effective practice improvement meetings
Maintains databases directly associated with role
Effectively collaborates with team members in the Clinical organization as well as Medical Directors, local Network leads, HCE Analysts and Clinical Analysts in support of the program
Assists and supports leaders in summarizing and disseminating experience-related learning by way of team updates, written reports/articles, and/or presentations as called for by directors

Clinical Practice Consultant Resume Examples & Samples

Intermediate level Microsoft office experience
Performance Improvement experience
Experience with NCQA
HEDIS / STARS Experience

Clinical Practice Consultant Supervisor Resume Examples & Samples

Reports directly to the Director of Quality Improvement
Coordinates and performs onsite medical record reviews at provider offices to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards, and where assigned investigation of quality of care and member complaints relative to quality of care and service
Supports continuum of member care by identifying members in need of health education, case management, etc
Educates providers and office staff on proper coding and billing practices, HEDIS and state-mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria. Solicits identification of barriers the office faces in providing care to members
Manages subordinate Clinical Practice Consultants, to include
Bachelor's degree (B.A.) from four-year college or university
Current RN unrestricted license
5-8 years related experience and / or training or experience / education
Knowledge base of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements and the managed care industry
Write reports, business correspondence and procedure manuals
Effectively present information and respond to questions from groups of managers, clients, customers and the general public
Calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference and volume
Apply concepts of basic algebra and geometry
Define problems, collect data, establish facts and draw valid conclusions
Interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables
Ability to travel to physician offices 90-100% of the time within the assigned territory
Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft Outlook and Internet browsers, Proficiency with Microsoft Access and PowerPoint software
Ability to evaluate medical records with attention to detail
Ability to interact with medical staff, peers and internal company staff at all levels
Ability to make formal presentations in front of committee and work group environments
Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others

Clinical Practice Consultant Resume Examples & Samples

Masters preferred but not required　
Working knowledge of hospital regulations and standards　
Experience in working with surveyors or in survey situations　
Understanding of hospital operations　
Experience in facilitating workgroups across a broad spectrum of participants 　
Knowledge of hospital regulations and standards　
Knowledge of Federal and State hospital regulations and Joint Commission standards, regulatory and accrediting agencies, and survey readiness principles
Demonstrated ability to communicate effectively verbally and in writing; one on one and in groups

Senior Clinical Practice Consultant Resume Examples & Samples

Serves as subject matter expert (SME) for assigned Medicaid HEDIS / CMS measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting Medicaid HEDIS / CMS Measures; consults with vendors to design and implement initiatives to innovate and then improve Medicare HEDIS / CMS Measure rates
Educates providers and office staff on proper clinical documentation, coding and billing practices, CMS mandated quality metrics specifications, provider profiling and pay for performance measurement and medical record review criteria, to drive quality improvement
Works with providers on standards of care, and advises providers on established clinical practice guidelines and appropriate documentation and billing consistent with CMS specific measures and technical specifications
2 years of Medicaid experience

Hedis Clinical Practice Consultant Resume Examples & Samples

Current unrestricted RN / LPN licensure for the state of Massachusetts and 2 years of HEDIS, quality improvement or managed care experience
3-5 years of HEDIS or quality improvement experience
Health care and insurance industry experience
Knowledge of one or more of: clinical standards of care, preventive health standards, NCQA, governing and regulatory agency requirements, and the managed care industry

Clinical Practice Consultant Resume Examples & Samples

Serves as subject matter expert (SME) for assigned HEDIS/State Measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting HEDIS/State Measures; consults with vendors to design and implement initiatives to innovate and then improve HEDIS/State Measure rates
Educates providers and office staff on proper clinical documentation, coding, and billing practices, state-mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria, to drive quality improvement
Documents and refers providers' non-clinical/service issues to the appropriate internal parties, to include Provider Relations and the Plan Chief Medical Officer by analyzing provider records and maintaining database
RN or Foreign Medical Graduate
3+ years clinical experience in a physician practice, outpatient facility or a FQHC
2 years of experience with Medicaid with an emphasis on Pediatrics
1 year of recent HEDIS experience
Experience with data extraction, data analysis and excel (pivot tables)
Knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, governing and regulatory agency requirements and the managed care industry

Senior Clinical Practice Consultant Resume Examples & Samples

*Candidate must live in Bullhead or Phoenix, Arizona as this is a telecommuter position working with providers in these areas***
Current unrestricted Arizona RN licensure
2+ years of quality improvement experience or other relevant experience

Senior Clinical Practice Consultant Resume Examples & Samples

Work with the practice and Optum to align and integrate Optum care / disease management programs and population health services to augment the practice’s capabilities, support their care management efforts and add value to the patient care experience
5+ years of experience in at least one of the following: quality improvement, practice management, medical management, health care analytics, managed care contracting OR experience in a primary care or multi - specialty practice that has successfully implemented PCMH, ACO programs or quality improvement initiatives
Demonstrated experience implementing Clinical Practice Transformation initiatives designed to help provider or hospital groups achieve large - scale health transformation goals

Clinical Practice Consultant Resume Examples & Samples

*Work from Home***
Participates, coordinates, and / or represents the Health Plan at community based organization events, clinic days, health department meetings, and other outreach events focused on quality improvement, member health education, and disparity programs as assigned
Educates providers and office staff on proper clinical documentation, coding, and billing practices, state - mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria, to drive quality improvement
Documents and refers providers' non - clinical / service issues to the appropriate internal parties, to include Provider Relations and the Plan Chief Medical Officer by analyzing provider records and maintaining database
Current unrestricted RN licensure required in state of Pennsylvania
2+ years of HEDIS experience
Multilingual candidates

Hedis Clinical Practice Consultant Resume Examples & Samples

Must meet one of the following requirements
Data collection
Medical Auditing
HEDIS and / or STARs experience
Health care, Managed care and / or insurance industry experience

Clinical Practice Consultant Resume Examples & Samples

Serves as subject matter expert (SME) for assigned Medicaid/Medicare HEDIS / CMS measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting Medicaid/Medicare HEDIS / CMS Measures; consults with vendors to design and implement initiatives to innovate and then improve Medicaid/Medicare HEDIS / CMS Measure rates
Works with providers on standards of care, and advises providers on established clinical practice guidelines, and appropriate documentation and billing consistent with CMS specific measures and technical specifications
Current, unrestricted RN license in the State of AZ
2 years of Medicare / Medicaid experience
Intermediate level in software applications that include, but are not limited to, Microsoft Word and Internet

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