Clinical Support Specialist
3 weeks ago
Job Summary
The Clinical Support Specialist will play a pivotal role in guiding independent primary care practices to fully leverage the benefits of Blue Shield of California's value-based care strategy. This role supports practices in optimizing clinical quality and performance under the Primary Care Hybrid and Fee-for-Service Plus payment models.
Key Responsibilities
- Manage clinical aspects of the Primary Care Hybrid and FFS+ Payment Models from initiation through delivery and monitor for continuous improvement with a focus on clinical quality and resource utilization.
- Educate and work with external partners and participating practices to maximize their performance on outcomes of the value-based payment models.
- Plan and execute initiatives to improve quality performance within specific value-based payment models.
- Conduct data analysis, including leveraging dashboards, Excel, and the Blue Shield of CA web-based value-based payment platform.
- Serve as a subject matter expert to internal stakeholders as they drive HEDIS, utilization, member and provider experience outcomes success, as well as support external partners in creating action plans to close care gaps.
- Exercise independent judgment in developing methods, techniques, and evaluation criterion for obtaining results.
- Participate in monitoring and evaluation of effectiveness of clinical support program.
Requirements
- Requires a Bachelor's degree or equivalent experience.
- Master's degree or clinical licenses preferred.
- Requires 7 years of experience in the related area.
- Experience of at least 2 years working in a healthcare setting (Health Plan or Provider setting) is preferred.
- Provider education experience on value-based payment models, HEDIS, or Medicare Stars is preferred.
- Project management experience is preferred.
- Clinical background (RN, MA, LVN, etc.) is preferred.
- Knowledge of change management concepts and techniques is preferred.
- Strong communication, meeting facilitation and presentation skills.
- Experience working well in a team, fostering a cooperative and productive environment.
- Proactive, solution-focused mindset with demonstrated creative, analytical and problem-solving skills.
- Proficiency in MS Outlook, Word, Excel, PowerPoint, Access.
Pay Range
The pay range for this role is: $109,120.00 to $163,680.00 for California.
Note
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
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