Clinical Quality Nurse Consultant

Blue Cross Blue Shield of Kansas • Topeka, KS • 9h ago

This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/13617099 **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.

Family Comes 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 Experience:

Associate Degree in Nursing (ADN) required. Bachelor\'s in nursing or health related field preferred.

Current unrestricted Kansas Registered Nurse (RN) licensure required.

Minimum of 5 years of RN clini

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