Clinical Program Consultant - Remote in Western Washington State

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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 continuous 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 (Apple 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.

• 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
• Participate, coordinate, or represent the Health Plan at community‑based organization events, clinic days, health department meetings, and other outreach 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 outreach initiatives
• Collaborate with maternal‑child health, care management, behavioral health, and community outreach teams to address unmet behavioral health diagnostic or treatment needs
• Support health equity and disparity reduction strategies specific to Medicaid populations, including culturally responsive outreach and coordination with community‑based organizations
• Serve as a resource for providers related 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 related to behavioral health

You will 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.

• 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…