Sr Clinical Consultant Blue Distinction

Blue Cross and Blue Shield Association • Chicago, IL 60602

Posted 2 weeks ago

Job Description

Overview

Evaluates provider quality performance and associated deliverables for Blue Distinction programs though all phases of

designation cycle. Functions as clinical SME on quality and cost measures and methodology used within selection criteria.

Ensures data collected meets the needs for evaluating provider performance. Engages internal and external key

stakeholders throughout designation process.

Responsibilities

Responsibilities include but are not limited to:

* Leads development, evolution and clinical implementation of BD programs. Prepares related evaluation tools,

such as survey development and program documentation. Responds to Plan and facility inquiries on clinical

selection criteria.

* Provides clinical and coding input into quality and cost evaluation and leads designation data analysis including

participation in threshold setting analytics. Builds consensus on recommendation of scored metrics. Develops

related methodology documentation.

* Drives communication of designation process and analytic results for internal decision making and

communication to Plans and external audiences. Conducts meetings for appeals and reconsiderations of

designation status. Creates documentation for governance and workgroup meetings on BD projects.

* Function as Blue Distinction liaison to internal and external stakeholders, particularly medical specialty

organizations/registries. Follows market and industry activities/initiatives related to BD programs and leads

feedback on measurement related activities as needed.

Qualifications

Required Basic Qualifications:

* 4-year College Degree

* Clinical degree, nursing or other advanced clinical degree

* 5 years related work experience, within minimum of 3 years in clinical or measurement role

* Knowledge and prior experience with quality evaluation processes

* Working knowledge of Microsoft Office Suite

Preferred Basic Qualifications:

* Master's Degree

* Understanding of managed care or health benefit plans

* Experience with quality improvement and performance measurement initiatives and organizations.

* Technical knowledge of statistics and related analyses of biostatistics including patient outcome statistics

Equal Opportunity Employer

Blue Cross Blue Shield Association is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, gender identity, disability, veteran status, genetic information or any other legally protected characteristics

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