Clinical Practice Consultant -Southwest Virginia Job Abingdon Virginia USA,Healthcare

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The Clinical Practice Consultant (CPC) is a direct, provider facing role responsible for supporting physician practices through targeted clinical quality improvement initiatives. This position partners closely with providers to improve performance on state and federal quality measures, close care gaps, and support compliance with contractual and regulatory requirements.

This role reports to the Associate Director of Clinical Quality and collaborates with internal and external stakeholders to drive sustainable improvements in provider's performance.

If you reside within a commutable distance of Southwest Virginia, you will have the flexibility to work remote while engaging in up to 75% same-day travel to provider locations.

* Ideal candidates will be located within Virginia and near Russell, Smyth, Tazewell, or Washington counties.

This is a Field Based position with a Home-Based Office.

Primary Responsibilities:

Operational & Program Support:
- Serve as a subject matter expert (SME) for assigned HEDIS/State Measures and preventive health topics
- Support state specific medical record retrieval and quality initiatives as directed by Quality Leadership
- Review medical records and internal systems to identify and address open care gaps
- Assist with development of SOPs, job aids, and educational materials for internal and external use
- Represent the health plan at provider meetings, clinic days, and community or public health focused events
- Identify opportunities to improve operational efficiency and effectiveness
- Perform additional duties supporting quality programs and health plan initiatives as needed
Provider & Practice Support:
- Develop strong relationships with targeted provider groups to drive improvement in clinical quality performance
- Serve as a trusted liaison between providers and internal teams, to address operational, network, claims, and service-related needs to enhance the provider experience
- Analyze large volumes of clinical data, translate findings into actionable opportunities for providers, and track interventions through completion
- Apply creative strategies to engage providers
- Conduct medical record audits to assess documentation, coding, and billing practices
- Assess performance trends and deliver targeted clinical, quality, and coding best practices to support quality outcomes
- Lead year-round medical record retrieval, review, and submission activities to support care gap closure
- Anticipate, understand, and address the needs of internal and external stakeholders

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

Required Qualifications:

3+ years of clinical or clinical quality experience
Intermediate level of proficiency with Microsoft Word, Excel, and Power Point
Intermediate level of proficiency using multiple systems/applications simultaneously
Willingness and ability to travel up to 75% within the assigned market
Driver's license and access to reliable transportation

Preferred Qualifications:

Current unrestricted RN or clinical background (RN, LPN, MA, or equivalent experience)
2+ years of clinical quality improvement experience

Soft Skills:

Ability to communicate effectively with diverse audiences including physicians,…