Clinical Quality Nurse Consultant

Springfield, MO, USA|Remote, Onsite

Job Overview

Compensation

Salary

Range $73,920.00 - $92,400.00

Benefits

Health Insurance

Vision Insurance

Dental Insurance

Paid parental leave

fertility assistance

Adoption assistance

paid caregiver leave

401(k) plan matching

Tuition Reimbursement

Health and fitness benefits

Job Description

Blue Cross Blue Shield of Kansas (BCBSKS) is a well-established health insurance company with a legacy of over 80 years committed to serving the Kansas community with compassion and dedication. Known for its trusted and stable presence in the healthcare industry, BCBSKS focuses on providing affordable, quality health coverage and promoting wellness among its members. The company prides itself on fostering an inclusive workplace environment where employees feel valued and respected, contributing to a positive and dynamic work culture. BCBSKS also offers exceptional total rewards packages that emphasize the importance of work-life balance, offering paid vacation, sick leave, as well as paid maternity and paternity leave immediately upon hire. In addition to competitive benefits like health, vision, and dental insurance, the company supports employees' professional growth through ongoing training and development programs, along with fertility and adoption assistance and tuition reimbursement. BCBSKS offers flexible work arrangements, including remote, hybrid, and onsite options, for eligible positions, demonstrating its commitment to adaptability in modern work environments.

The role of Clinical Quality Nurse Consultant at BCBSKS is a critical position that serves as a clinical liaison between the health insurer, healthcare providers, and members to drive quality improvement, care coordination, and value-based care initiatives across all business lines. This position is responsible for partnering with providers and internal teams to implement data-informed clinical processes that enhance quality outcomes and ensure compliance with regulatory and accreditation standards. The Nurse Consultant applies clinical expertise in quality measurement, care coordination strategies, and HEDIS performance, supporting BCBSKS's goals of improving member experience, affordability, and clinical quality. Reporting directly to the Manager of Clinical Quality and Accreditation, the role requires the ability to work independently or collaboratively in a vibrant team environment dedicated to healthcare excellence. Applicants must reside or be willing to relocate to Kansas or Missouri, with flexible telecommuting options available. The position offers a competitive salary range from $73,920 to $92,400 annually, classified under Exempt Grade 15. This opportunity is ideal for experienced registered nurses with a background in clinical quality improvement who are passionate about impacting community health and driving systemic improvements in healthcare delivery.

Job Requirements

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
Associate Degree in Nursing (ADN)
Current unrestricted Kansas Registered Nurse (RN) licensure
Minimum of 5 years of RN clinical experience
Certified Professional Coder (CPC) certification required within two years of hire

Job Qualifications

Associate Degree in Nursing (ADN)
Bachelor’s degree in nursing or health-related field preferred
Current unrestricted Kansas Registered Nurse (RN) licensure
Minimum of 5 years of RN clinical experience
Minimum 3 years experience in clinical quality improvement or quality measurement activities preferred
Certified Professional Coder (CPC) certification required within two years of hire

Job Duties

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