Clinical Practice Consultant (Healthcare Quality)

Location: Fully remote within the continental United States; California, New York, Alaska, and Hawaii are excluded. Local and overnight travel may be required.

Base pay: $76,600–$138,500 annually, plus eligibility for an annual incentive bonus.

Company

hirify.global is a health insurance organization focused on quality improvement, value-based care, and provider partnerships.

What you will do

• Support quality imperatives, value-based care models, and provider relationships across assigned medical practices and primary care providers.
• Improve targeted HEDIS measures through clinical readiness assessments, provider engagement, and operational improvements.
• Develop clinical models and programs, support joint operating committees, and obtain electronic medical record access.
• Implement provider-based member outreach initiatives and supplemental data submissions, and retrieve medical records throughout the year.
• Evaluate the effectiveness of quality improvement programs and provide consultative support to clinical operations, care coordination, and network management teams.
• Build collaborative relationships with medical directors, clinic directors, physicians, and clinical and operational stakeholders.

Requirements

• Current, unrestricted license as a Registered Nurse, Physician's Assistant, or Nurse Practitioner in the state of operations.
• At least four years of experience in health insurance, managed care, or medical group insurance.
• Knowledge of federal and accreditation standards and regulations for the health insurance industry.
• Experience designing clinical programs and conducting member or provider training presentations.
• Ability to collaborate with physicians, work independently, communicate effectively, and influence internal and external stakeholders.
• Must be located in the United States; visa sponsorship is not available.

Nice to have

• Residence in Florida, Georgia, Alabama, Mississippi, South Carolina, North Carolina, New Mexico, Pennsylvania, Delaware, New York, New Jersey, or Connecticut.
• Experience improving HEDIS, STAR, quality, or performance metrics through provider engagement.
• Experience with population health, value-based care, performance data analysis, practice transformation, or workflow improvement.
• Ability to travel locally 20% or less to engage with hospital systems.

Culture & Benefits

• Fully remote work within the eligible United States locations.
• Curated professional development plans and career growth support.
• Health and wellness benefits, 401(k) savings plan, pension plan, paid time off, and paid parental leave.
• Disability insurance, supplemental life insurance, employee assistance, paid holidays, and tuition reimbursement.