Physician Network Clinical Specialist: RN/LPN

Position Summary

The Physician Network Clinical Specialist: RN/LPN, is a member of the CSMS-IPA value-based care team. This position is responsible for the development and implementation of all clinical initiatives to fulfill the organization’s mission and vision. Active engagement with physician network is critical to ensure effective patient management and implementation of clinical initiatives to achieve success in health plan collaborations.

Salary commensurate with expertise & experience.

Essential Responsibilities

• Develop and maintain detailed understanding of HEDIS and STAR measures to help organizational success in these areas
• Develop knowledge base of all health plan collaboration goals, population health tools, risk adjustment and performance measures
• Development of Clinical Action Plans for all collaborations
• Develop and lead the implementation of clinical/quality initiatives aligned with CSMS-IPA collaboration goals
• Develop and support quality assurance/process improvement (QAPI) initiatives and activities to improve efficiency across the healthcare spectrum including acute inpatient care, SNFs, ED visits, specialty referrals and diagnostic referrals
• Design and implement Transition of Care initiatives to effectively reduce readmissions
• Responsible for the clinical care rounds program with physicians/staff and health plan partner (as appropriate)
• Identify high-risk members and ensure development of high-risk member care plans by practices to meet payor requirements
• Conduct clinical care rounds with physicians/staff and health plan partner (as appropriate)
• Use population health tools and reports to inform and assist practice in its population management
• Analyze assigned practice data and identify patient gaps in care and chronic condition capture rate for review with assigned practices
• Support practices in review of member rosters from the payor or population health tools to improve member alignment
• Conduct on-site and virtual visits with healthcare providers and/or their staff to educate on population health tool entries, coding guidelines, and practice performance
• Document and record all practice contacts and tasks electronically
• Responsible for collection of medical records requested by health plan partners
• Audit physician office compliance of clinical records to population health tool entries
• Foster and maintain relationships with payor partners
• Serve as a resource to CSMS-IPA value-based care team in analysis of practices high risk/high-cost patients
• Attend and facilitate clinical meetings with health plans
• Educate and encourage appropriate referrals by physicians and their staff on available payer sponsored programs such as disease and complex case management
• Conduct on-site and virtual visits with participating practices to fulfill duties and responsibilities
• Instruct and support practices in the use of population health tools to manage clinical needs of patients
• Prepare and submit clinical reports internally and externally
• Plan and coordinate physician practice training and sessions
• Staff Liaison to the Clinical Care Management Committee
• Ensure CSMS-IPA clinical resources on the organization’s website are current and adequate to support our membership
• Write articles for newsletters
• Participate in the CSMS-IPA webinars as assigned
• Document and record all practice contacts and tasks electronically
• Other duties as assignment

Education, Knowledge and Skills:

Candidate must be a Registered Nurse/Licensed Practical Nurse with 5 years of experience in the healthcare field. Candidate should possess knowledge of care coordination, care planning, quality improvement, patient centered medical homes, value-based care, physician practice administration, HEDIS and Star quality measures.

Skill set must include:

• Quality/Process Improvement
• Read and analyze population health reports
• Able to work independently and as a team member
• Clinical Program design
• Computer proficiency in word office suite
• Strategic thinking
• Highly organized
• Excellent written and oral skills and capability
• Interpersonal Skills
• Ability to problem solve
• Public speaking
• Self-Starter

Licensure and Certification:

• Registered Nurse/Licensed Practical Nurse with a current license in the State of CT
• Valid CT driver’s license and employee must maintain, at employee’s expense, an automobile for the provision of the duties, and responsibilities described herein, as well as automobile liability insurance coverage.

Working Conditions:

Hybrid position with regular travel statewide to physician practices and organizational meetings.

• The above statements are intended to describe the general nature and level of work being performed by employees in this position. They are not intended to be an exhaustive list of all duties, responsibilities, and qualifications of employees assigned to this job.

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Health savings account
• Paid time off
• Vision insurance

Experience:

• Healthcare: 5 years (Required)

License/Certification:

• RN/LPN License (Required)

Willingness to travel:

• 50% (Required)

Work Location: Hybrid remote in Shelton, CT 06484