The Clinical Consultant is the main clinical liaison to the HPHC Provider network, which includes LCUs (local care units), IDSs (integrated delivery systems) and hospitals. He/she is responsible for the implementation and maintenance of Network Medical Management (NMM) programs across the Provider network. He/she works with the NMM team and others to evaluate provider utilization and quality data to assist in network evaluation and program development.
Build and maintain collaborative relationships with provider network leadership to promote engagement with Harvard Pilgrim programs, optimize performance, and foster information exchange between HPHC and its network.
Serve as the point person for all medical management questions and issues submitted by the LCU, IDS or hospital. Promptly resolve concerns or elevate to the appropriate level.
Engage network leaders in the process of sharing best practices so as to inform HPHC programs.
Participate in strategically important external performance meetings.
Participate in the implementation of the new Care Delivery Model program.
Work collaboratively with leadership at established pilot sites to ensure optimal project execution.
Manage operations of NMM programs, including physician and hospital pay-for-performance programs, provider recognition programs, and the quality grants program.
Administer all facets of network-wide incentive and reward programs.
Present NMM programs to internal and external stakeholders.
Accurately track large numbers of contractual deliverables, results and payouts and remedy deficiencies promptly.
Review and analyze data to assess network utilization and quality performance. Advise NMM leadership on performance improvement opportunities.
Use knowledge of care delivery models, provider contracting and payment models to analyze performance of network providers.
Apply clinical knowledge and experience to the interpretation of network utilization and practice variation.
Assist in the design of interventions to advance local quality and efficiency initiatives and provide consultative support to provider entities.
Assist in planning the regional Medical Director meetings and other forums to support NMM programs and other corporate initiatives.
Other duties and projects as assigned.
This is a part-time position.
Registered Nurse (BSN), Physician Assistant or other clinical degree with current Connecticut licensure. Masters degree preferred.
Seven years professional experience, including significant clinical experience; 3-5 years managed care experience preferred, which might include experience in pay-for-performance and/or quality assessment programs.
Professionalism and service orientation, as the Clinical Consultant works with a wide variety of clinicians and administrators, addressing a broad scope of network issues.
Must be able to meet or exceed diverse expectations on a daily basis.
Analytical skills and the ability to interpret health care data, required.
Project management experience desirable, including excellent organizational skills and the ability to manage multiple projects simultaneously.
Teamwork and collaboration with internal and external stakeholders expected.
Excellent written and verbal communication skills.
Experience with MS Office, including Excel, Word and Power Point.
Familiarity with MS Access is a plus
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