Quality and Risk Adjustment - Provider Clinical Consultant - Premera Blue Cross

**Join Our Team: Do Meaningful Work and Improve People's Lives** Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare. To better serve our customers, we're creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives! As a result of these efforts we are proud to share that Forbes ranked Premera among America's 2023 Best Midsize Employers (https://www.forbes.com/lists/best-midsize-employers/?sh=58210f5e210f) and America's 2023 Best Employers By State (https://www.forbes.com/lists/best-employers-by-state/?sh=21c7c3d1983b) . Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com . In partnership with Premera Medical Directors and Provider Network Executives, the **Quality and Risk Adjustment - Provider Clinical Consultant (PCC)** works directly with providers to evaluate, recommend, and monitor the implementation of better practice processes for improved outcomes that focus on keeping Premera members healthy. The Provider Clinical Consultant will work directly and build relationships with care providers; proactively identify performance improvement opportunities through data analysis and discussion with subject matter experts; consult with providers to assess and recommend processes and procedures to ensure high quality and timely care to our members; recommend ways to optimize IT tool (e.g.; electronic health record, population health management software) use; and ensure adequate training is available for documentation and coding best practices for HEDIS and risk adjustment. This role will have a positive impact on our clinical quality and coding quality work. This position will work in the field and remotely with clinicians, administrators, coders/billers and other operational team members, and will maintain bi-weekly/monthly operational level communication for support and performance reporting. **What you will do:** + Build and maintain strong professional relationships with provider organizations, including administrative and clinical staff as well as providers. Utilize consultative skills to develop and execute strategies to influence provider behavior. + Educate and communicate concepts related to risk adjustment, documentation, and coding best practices. Partner with Coding Quality Educators to identify opportunities to review providers' medical records to better understand knowledge and performance gaps with respect to risk adjustment documentation and coding, engage providers to bridge those gaps through training programs, offering Premera material, curriculum and subject matter support. + Clearly, communicate nationally established HEDIS measures and be able to speak to the measure's technical specifications and reporting requirements. + Work with providers to improve the ability to report on those measures via data extracts and use of reporting codes. + Convey relevant utilization management best practices, Premera medical policies, and pharmacy/pharmacy benefit manager utilization management activities. + Consult with Medical Directors, Provider Network Management and Solutions, Healthcare Economics, Corporate Data, and Informatics and other key Premera stakeholders to support provider capability to provide quality and timely care to members. Partner effectively with medical directors and provider network executives while also working independently. + Assess configuration and use of the provider tools that support population health and care management (EMR, billing and scheduling software, population health tools, etc.). Make recommendations for enhancements to configuration, workflows and/or processes to support better care for Premera members. + Understand how to use established and signed risk-based and shared savings contracts, and performance incentives to compel providers to engage Premera's members to receive the right care at the right time. + Use effective presentation and facilitation techniques to support the delivery of training initiatives and customized training developed for diverse provider audiences. Lead and facilitate workgroup meetings, including setting objectives and measuring progress. **What you will bring:** + Bachelor's degree or four years of relevant work experience **(Required)** + Four years of experience in practice management or an administrative leadership role in a primary care setting **(Required)** + An ability to travel frequently across the assigned territory for in-person provider support + RHIA, RHIT, CRC, or CPC certified coder or auditor (CMAS) (Preferred) + LPN or RN (Preferred) **What we offer** + Medical, vision and dental coverage + Life and disability insurance + Retirement programs (401K employer match and pension plan) + Wellness incentives, onsite services, a discount program and more + Tuition assistance for undergraduate and graduate degrees + Generous Paid Time Off to reenergize + Free parking **Equal employment** **opportunity/affirmative** **action:** Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law. If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785. **Premera is hiring in the following states, with some limitations based on role or city:** Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin _._ The pay for this role will vary based on a range of factors including, but not limited to, a candidate's geographic location, market conditions, and specific skills and experience. **National Salary Range:** $70,100.00 - $119,200.00 **National Plus Salary Range:** $79,900.00 - $135,800.00 _*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska_ _._ At Premera, we make healthcare work better. By focusing on improving our customers' experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives. As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services. Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.