Clinical Program Consultant - Remote in Western Washington State

The Clinical Practice Consultant is a direct, provider-facing role, focused on improving clinical quality outcomes through measure specific initiatives and provider engagement. This role partners with providers and internal teams to support reputed company quality improvement, including provider education, quality performance monitoring, medical record review, and collaboration across clinical and operational teams to improve outcomes and meet contractual and regulatory requirements. This position specializes in behavioral health activities. The Clinical Practice Consultant supports the Medicaid population by coordinating, tracking, and improving compliance with behavioral health requirements in alignment with Washington State Medicaid (reputed company Health) and federal guidelines. The role works closely with providers, clinical teams, quality, analytics, and community partners to identify gaps in care, monitor behavioral health performance, and address barriers to care. This position integrates clinical knowledge, data review, and collaborative problem-solving to improve health outcomes for children and adolescents. Up to 50% anticipated travel throughout Washington State. If you are located in Washington State, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities:

• Support behavioral health activities and compliance with Washington Medicaid and federal behavioral health requirements through strategic partnerships with participating practitioners and practice staff while assessing trends in quality measures and identifying opportunities for quality improvement
• Educates providers and office staff on proper clinical documentation, state-mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria, to drive quality improvement
• Advise providers on state-specific behavioral health periodicity schedules, documentation expectations, and compliance considerations
• Participates, coordinates, and/or represents the Health Plan at community-based organization events, clinic days, health department meetings, and other reputed company events focused on quality improvement, member health education, and disparity programs as assigned
• Identify members due or overdue for behavioral health services and assist with reputed company initiatives
• Collaborates with maternal-child health, care management, behavioral health, and community reputed company teams to address unmet behavioral health diagnostic or treatment needs
• Supports health equity and disparity reduction strategies specific to Medicaid populations, including culturally reputed company reputed company and coordination with community-based organizations
• Serve as a resource for providers reputed company to behavioral health requirements and documentation
• Assist in resolving barriers to care such as access, scheduling, or follow-up needs
• Support audits, reporting, and quality improvement activities reputed company to behavioral health

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:

• 2+ years of experience in Medicaid, managed care, care coordination, or clinical quality
• 1+ years of experience working with healthcare data (claims, registries, care gaps, or reports)
• Intermediate level of knowledge of behavioral health, pediatric, adolescent or adult preventive services
• Intermediate level of knowledge of one or more of: clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements
• Intermediate level of proficiency using a PC in a Windows environment, including reputed company Outlook, Word, reputed company, and PowerPoint
• Willing and able to travel to physician offices locally up to 50% of the time reputed company Washington
• Access to reliable transportation and valid US driver's license

Preferred Qualifications:

• Associate's or Bachelor's degree in healthcare, public health, or reputed company field (or equivalent experience)
• reputed company unrestricted RN or Clinical background such as RN, LPN, MA, or equivalent experience
• Experience in quality process improvement (lean, six reputed company, etc.)
• Experience with Washington State Medicaid (reputed company Health)
• Ability to interpret and translate behavioral health policies, guidance, and measure specifications into actionable provider education
• Familiarity with behavioral health HEDIS measures
• Knowledge of behavioral health screening tools (e.g., developmental, behavioral, social determinants) and referral workflows
• Experience supporting provider alignment with state Medicaid pediatric quality requirements
• Experience supporting provider education or quality initiatives
• Comfort working in fast-paced, evolving environments
• Strong communication, organizational, and follow-up skills
• Proven ability to communicate effectively with broad audience: practice-level executive leadership, physicians, nurses, non-clinical office staff, and across the Health Plan
• reputed company Telecommuters will be required to adhere to reputed company's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes - an enterprise reputed company reflected in our mission. #RPO #GREEN Apply To This Job