Clinical Program Consultant - Remote in Western Washington State

About the role

The Clinical Practice Consultant is a direct, provider-facing role aimed at 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 enhance outcomes and meet contractual and regulatory requirements.

Responsibilities

• 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.
• Serves as a subject matter expert (SME) for assigned HEDIS/State Measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting HEDIS/State Measures; consults with vendors to design and implement initiatives to innovate and then improve HEDIS/State Measure rates.
• Coordinates, tracks, and improves compliance with quality and regulatory requirements in alignment with Washington State Medicaid (Apple Health) and federal guidelines, working closely with providers, clinical teams, quality, analytics, and community partners to identify gaps in care, monitor performance, and address barriers to care.
• Supports health equity and disparity reduction strategies, including culturally responsive outreach and coordination with community-based organizations.
• Assists in resolving barriers to care such as access, scheduling, or follow-up needs.

Requirements

• 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 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.
• 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).
• Experience supporting provider alignment with state Medicaid quality requirements.
• Experience supporting provider education or quality initiatives.
• Familiarity with HEDIS measures (e.g. CBP, CHL, FUA).

Preferred Qualifications

• Proven comfort working in fast-paced, evolving environments.
• Proven ability to interpret and translate health policy, guidance, and measure specifications into actionable provider education.
• Proven solid 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.
• Proven background in preventive health and condition management.
• Reside in Pierce, King or Thurston.

Benefits

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).