Blue Cross of Idaho · 5 hours ago
Clinical Practice Consultant
Meridian - Main
Full-time
Onsite
Mid, Senior Level
$78K/yr - $117K/yr
5+ years expBlue Cross of Idaho is seeking a Clinical Practice Consultant who will be responsible for the value creation, impact, and cost control of provider partners engaged in value-based reimbursement programs. The role involves providing strategic support to primary care providers, analyzing performance metrics, and developing plans for workflow transformation to enhance performance in value-based reimbursement initiatives.
Health InsuranceInsurance
Responsibilities
Deliver office based, hands on consultative workflow transformation and training/education services to providers enrolled in Blue Cross of Idaho value based reimbursement programs and clinical evidence based guidelines
Identify, develop, and implement clinical cost and quality improvement projects based on claims, utilization, and medical cost data review in accordance with regulatory agency standards and accreditation agency requirements
Identify and lead performance improvement projects that maximize provider value based reimbursement
Evaluate the effectiveness of each project and assure implementation of corrective action plans that improve performance
Transform PCP practices enrolled in value based reimbursement program(s) using innovative continuous improvement methodologies
Analyze and interpret provider value based reimbursement reports in the areas of National Quality Standards like NCQA, HEDIS, NQF, PQRS etc. Develop strategic plans to meet target performance metrics, and implement strategic plans in partnership with the provider and plans
Provide assistance in the use of health information data exchanges, user interfaces, predicative analytic tools, and other population health management tools
Identify business requirements for Blue Cross of Idaho data analytics that support provider partners in identifying and meeting value based reimbursement targets
Educate value based care providers regarding alternative care programs and research available options including costs and appropriateness of patient placement
Qualification
Required
5 years primary/ambulatory care environment, health industry, healthcare administration, population health management, or related experience
Bachelor's Degree Nursing, Healthcare Administration, Public Health, Business Administrations, related course of study, or equivalent work experience (Two years' relevant work experience is equivalent to one-year college)
Travel required
Program design and process improvement
Excellent written and verbal communication
Strong relationship management and facilitation
Work independently and proactively
Design and develop quality performance programs
Develop and deliver professional presentations on findings
Compare trends over time and find opportunities for improvement
Travel up to 25%
Preferred
Experience in data analysis, interpretation, and outcomes strategic plan development
Experience in health plan provider network performance management, population health management, continuous improvement or provider engagement models
Experience with value based reimbursement programs
Benefits
Paid time off
Paid holidays
Community service and self-care days
Medical/dental/vision/pharmacy insurance
401(k) matching and non-contributory plan
Life insurance
Short and long term disability
Education reimbursement
Employee assistance plan (EAP)
Adoption assistance program
Paid family leave program
Company
Blue Cross of Idaho
Blue Cross of Idaho operates as a health insurance company.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Sameer Sonalkar
SVP & CIO, Blue Cross of Idaho
Recent News
2025-07-28
2025-07-28
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