Clinical Program Consultant - Remote in Western Washington State

Primary Responsibilities

• 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
• Participates, coordinates, and/or represents 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
• Collaborates with maternal-child health, care management, behavioral health, and community outreach teams to address unmet behavioral health diagnostic or treatment needs
• Serve as a resource for providers related to behavioral health requirements and documentation
• Aid in resolving barriers to care such as access, scheduling, or follow-up needs
• Support audits, reporting, and quality improvement activities related to behavioral health

Required Qualifications

• 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 Microsoft Outlook, Word, Excel, and PowerPoint
• Willing and able to travel to physician offices locally up to 50% of the time within Washington
• Access to reliable transportation and valid US driver's license

Preferred Qualifications

• Associate's or Bachelor's degree in healthcare, public health, or related field (or equivalent experience)
• Current unrestricted RN or Clinical background such as RN, LPN, MA, or equivalent experience
• Experience in quality process improvement (lean, six sigma, etc.)
• Experience with Washington State Medicaid (Apple Health)
• Familiarity with behavioral health HEDIS measures
• Knowledge of behavioral health screening tools (e.g., developmental, behavioral, social determinants) and referral workflows
• Experience supporting provider alignment with state Medicaid pediatric quality requirements
• Experience supporting provider education or quality initiatives
• Comfort working in fast-paced, evolving environments
• Strong communication, organizational, and follow-up skills
• Proven ability to communicate effectively with broad audience: practice-level executive leadership, physicians, nurses, non-clinical office staff, and across the Health Plan