Provider Engagement Clinical Professional

Glen Allen, Virginia

Posted in Insurance
10 days ago

Job Info


The Senior Provider Engagement, Clinical Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Senior Provider Engagement, Clinical Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.


The Senior Provider Engagement, Clinical Professional represents the scope of health plan/provider relationship across such areas as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence. This work focuses on areas of clinical emphasis. Begins to influence department's strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, andwork is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

Required Qualifications

  • BSN or Associate Degree in Nursing
  • Nursing license unrestricted in the state of Virginia
  • 5+ years of experience working as a registered nurse
  • Excellent Communication skills
  • Excellent Organizational Skills
  • Well versed in Microsoft office, Excel and PowerPoint
Preferred Qualifications
  • 3-5 years of managed care experience
  • 3-5 years of case management experience
  • HEDIS knowledge
  • Experience with Medicare STARs program
Additional Information

For "remote/work at home" associates, Must ensure designated work area is free from distractions during work hours and virtual meetings Must provide a high-speed DSL or cable modem for a workspace (Satellite and Hotspots are prohibited). A minimum standard speed of 10x1 (10mbs download x 1mbs upload) for optimal performance of is required

Scheduled Weekly Hours


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