Clinical Quality Nurse Consultant

Blue Cross Blue Shield of Kansas

Topeka, Kansas

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JOB DETAILS

SKILLS

Accreditation Standards, Analysis Skills, Clinical Data, Clinical Information, Clinical Nursing, Clinical Support, Clinical Training, Communication Skills, Consulting, Cross-Functional, Customer Experience, Dental Insurance, Establish Priorities, Fitness, Gap Closure, Healthcare, Healthcare Effectiveness Data and Information Set (HEDIS), Healthcare Quality, Incentive Programs, Medical Records, Metrics, Performance Management, Policy Development, Process Improvement, Project/Program Coordination, Quality Management, Quality Metrics, Regulations, Regulatory Compliance, Team Player, Training Program, Training/Teaching, Trend Analysis, Vision Plan

LOCATION

Topeka, Kansas

POSTED

9 days ago

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
FamilyComes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire
Professional Growth Opportunities: Advance your career with ongoing training and development programs.
Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.
Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.
Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.

Benefits & Perks

Base compensation is only one component of your competitive Total Rewards package
Incentive pay program (EPIP)
Health/Vision/Dental insurance
6 weeks paid parental leave for new mothers and fathers
Fertility/Adoption assistance
2 weeks paid caregiver leave
401(k) plan matching up to 5%
Tuition reimbursement
Health & fitness benefits, discounts and resources

Job Summary

The Clinical Quality Nurse Consultant serves as a clinical liaison between Blue Cross Blue Shield of Kansas (BCBSKS), providers, and members to support quality improvement, care coordination, and value-based care initiatives across all lines of business. This role partners with providers and internal teams to implement data-informed clinical processes, improve quality outcomes, and support regulatory and accreditation requirements. The Nurse Consultant provides clinical expertise in quality measurement, HEDIS performance, and care coordination while advancing organizational goals related to quality, affordability, and member experience. This position reports to the Manager, Clinical Quality & Accreditation.

"This position is eligible to work remotely, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."

What you'll do

Support clinical quality improvement and value-based care initiatives by partnering with providers and internal teams to improve quality outcomes across assigned populations and lines of business.
Provide clinical expertise related to quality measurement, including HEDIS metrics, care coordination strategies, and performance improvement activities.
Collaborate with provider offices to implement workflows, tools, and processes that support population health management, care coordination, and quality gap closure.
Participate in quality oversight activities, including medical record reviews and peer review processes, serving as a clinical resource for committees such as the Administrative Quality Committee (AQC) as assigned.
Prepare and contribute to quality reports, summaries, and presentations supporting departmental, divisional, and corporate quality objectives.
Collaborate with cross-functional teams to identify trends, opportunities, and educational needs related to quality measurement and clinical performance.
Support compliance with applicable regulatory and accreditation standards as part of routine clinical quality activities.
Serve as a clinical resource for internal staff, providers, and external partners related to quality improvement programs and care coordination solutions.
Contribute to the development and maintenance of policies, procedures, and training materials supporting clinical quality improvement and reporting activities.

What you need

Knowledge/Skills/Abilities:

Strong clinical knowledge and understanding of quality improvement principles and healthcare delivery systems.
Ability to communicate effectively with providers, internal stakeholders, and external partners.
Ability to work independently, prioritize work, and adapt to changing priorities.
Ability to analyze clinical information and identify trends or improvement opportunities.
Working knowledge of provider practice patterns, utilization, and care coordination models.
Understanding of business continuity and departmental recovery expectations.

Education and Experien

Clinical Quality Nurse Consultant

Blue Cross Blue Shield of Kansas

Topeka, Kansas

About the Company

Blue Cross Blue Shield of Kansas

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