Practice Consultant Sr at Elevance Health in Metairie, Louisiana

Posted in Other 21 days ago.

Job Description:


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.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

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 elevancehealthjobssupport@elevancehealth.comfor assistance.
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