Practice Consultant Sr

Location: Metairie, LA.

This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of the Elevance Health PulsePoint location listed above.

The Practice Consultant Sr will be responsible for creating and implementing quality provider and member initiatives within assigned markets which focus on driving performance guarantee outcomes and NCQA accreditation. Assesses quality performance of group and individual provider practices, identifies opportunities for improvement, assesses current practice patterns, assets and challenges, NCQA Standards, HEDIS audits, and medical record reviews. Drives quality improvement, ensures increased awareness surrounding HEDIS measure compliance and NCQA Standards, and ensures appropriate documentation. Responsible for multiple markets and states.

How you will make an impact:

• Works collaboratively with health plans to improve provider collaboration and quality member outcomes.

• Evaluates quality opportunities for implementation by establishing a project plan that identifies goals and objectives for improvement in partnership with providers.

• Works with provider offices to provide information on programs, share provider profile (scorecard) results and provider quality improvement reports in collaboration with

• Quality, Provider Relations and Provider Network teams.

• Provides support in the development and streamlining of communications, ensuring consistency across markets.

• Serves as first line contact for conflict resolution with providers, claims or service issues.

• Assists with development of program policies, guidelines and procedures.

• Assists management with providing oversight of day-to-day activities, ensuring operational excellence and efficient workflow.

• Participates in quality audit activities and provides constructive coaching and feedback.

• Serves as a preceptor for new staff.

• Also serves as the subject matter expert/resource for the team.

• Develops training materials, performs process evaluations and tests and monitors systems/process enhancements.

• Chairs meetings and presents key topics for discussion.

• Participates in interdepartmental and/or cross brand workgroups.

Minimum Requirements:

• Requires AS in nursing and minimum of 5 years of managed care experience and minimum of 3 years of clinical experience; or any combination of education and experience, which would provide an equivalent background.

• Current, unrestricted RN, NP, PA or LCSW required.

Preferred Skills, Capabilities, and Experiences:

• Minimum 3 years of professional presentation experience to small and large audiences preferred.

• BSN or MSN preferred.

• Experience in population health management preferred.