**Workforce Classification:** Telecommuter **Join Our Team: Do Meaningful Work and Improve People’s Lives** Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare. To better serve our customers, we are fostering a culture that emphasizes employee growth, collaborative innovation, and inspired leadership. We are dedicated to creating an environment where employees can excel and where top talent is attracted, retained, and thrives. As a testament to these efforts, Premera has been recognized on the 2025 America's Dream Employers (https://www.forbes.com/lists/americas-dream-employers/) list. Newsweek honored Premera as one of America's Greatest Workplaces (https://www.newsweek.com/rankings/americas-greatest-workplaces-2024) , America's Greatest Workplaces for Inclusion (https://rankings.newsweek.com/americas-greatest-workplaces-diversity-2025) , and America's Greatest Workplaces For Mental Well-Being (https://rankings.newsweek.com/americas-greatest-workplaces-for-mental-well-being-2025) , Forbes ranked Premera among America’s Best Midsize Employers (https://www.forbes.com/lists/best-midsize-employers/?sh=58210f5e210f) for the fourth time. Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/ . In partnership with Premera Medical Directors and Provider Network Executives, the **Provider Clinical Consultant (PCC), Quality and Risk Adjustment** works directly with providers to evaluate, recommend, and monitor the implementation of better practice processes for improved outcomes that focus on keeping Premera members healthy. The Provider Clinical Consultant will work directly and build relationships with care providers, proactively identify performance improvement opportunities through data analysis and discussion with subject matter experts, consult with providers to assess and recommend processes and procedures to ensure high quality and timely care to our members, recommend ways to optimize IT tool use (e.g.; electronic health records, population health management software, etc.), and ensure adequate training is available for documentation and coding best practices for HEDIS and risk adjustment. This role will have a positive impact on our clinical quality and coding quality work. This position will work in the field and remotely with clinicians, administrators, coders/billers, and other operational team members, and will maintain bi-weekly/monthly operational level communication for support and performance reporting. **What you’ll do:** + Build and maintain strong professional relationships with provider organizations, including administrative and clinical staff as well as providers. Utilize consultative skills to develop and execute strategies to influence provider behavior. Be able to travel frequently across the assigned territory for in-person provider support. + Understand and clearly communicate concepts related to risk adjustment, documentation, and coding best practices. + Understand and clearly communicate nationally established measures to include NCQA/HEDIS and be able to speak to each measure’s technical specifications and reporting requirements. + Understand and clearly convey relevant utilization management best practices, Premera medical policies, and pharmacy/pharmacy benefit manager utilization management activities. + Consult with Medical Directors, Provider Strategy and Solutions, Actuarial, Corporate Data and Analytics and other key Premera stakeholders to support provider capability to provide quality and timely care to members. Function well within the triad that includes medical director and provider network executive while also working independently. + Assess configuration and use of provider tools that support population health and care management (EMR, billing and scheduling software, population health tools, etc.) and make recommendations for enhancements to configuration, workflows, and/or processes to support better care for Premera members. + Understand how to use established and signed risk-based and shared savings contracts and performance incentives to compel providers to engage Premera’s members to receive the right care at the right time. + Develop and maintain training material, program documentation, and best-practice tools for use with providers. + Use effective presentation and facilitation techniques to support delivery of training initiatives and customized training developed for diverse provider audiences (clinicians, coders, support staff, practice managers, etc.). Lead and facilitate workgroup meetings including setting objectives and measuring progress. **What you’ll bring:** **Required Qualifications** + Bachelor’s Degree or (4) years of relevant work experience. + (4) years of experience in practice management or an administrative leadership role in a primary care setting. **Preferred Qualifications** + Master’s Degree in a related field. + Project management experience. + RHIA, RHIT, or CPC Certified Coder or Auditor (CMAS). + LPN or RN. **Knowledge, Skills, and Abilities** + Demonstrated successful verbal and written communication skills, including the ability to develop and deliver public presentations and trainings, and use of effective meeting facilitation techniques. + Proven ability to lead and direct teams addressing complex issues. + Understanding of open-access and standard scheduling templates, billing process and software, and EHR use and functionality. + Understanding patient and disease registries. + Understanding principles of risk adjustment and appropriate documentation, coding, and claims submission. + Understanding NCQA with HEDIS and CAHPS, and each measure’s technical specifications and reporting requirements. + Understanding of UM activities, interpretation of medical policies, and pharmacy/PBM activities. + Working knowledge of healthcare related organizations including Centers for Medicare and Medicaid Services, Centers for Medicare and Medicaid Innovation Center, Washington State Medicaid Agency, and regional quality improvement organizations. + Understand requirements for initiatives and programs including but not limited to Meaningful Use, Physician Quality Reporting System, Healthcare Effectiveness Data and Information Set (HEDIS), Quality Resource and Utilization Resource Reports and the Value Modifier Program, Medicare Shared Savings Program, Comprehensive Primary Care Plus, and Medicare Access & Children’s Health Insurance Program Reauthorization Act of 2015 (MACRA) Merit-Based Incentive Payment System (MIPS), and Alternative Payment Models (APMs). + Familiarity with and understanding of managed care contracting including risk-based and shared savings, premium base rates, and performance incentives. + Familiarity with data systems that can track and monitor clinical data across the continuum of ambulatory, acute and post-acute services. + Familiarity with clinically integrated analytics for data capture, validation, and gap analysis, performance collection, metric Requirements. + Intermediate proficiency level of Excel. **Physical Requirements** The following have been identified as essential physical requirements of this job and must be performed with or without an accommodation: + This is primarily a sedentary role which requires the ability to exert up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. + This role requires the ability to keyboard and to communicate clearly and understandably in person and over the telephone. **Premera total rewards** Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including: + Medical, vision, and dental coverage with low employee premiums. + Voluntary benefit offerings, including pet insurance for paw parents. + Life and disability insurance. + Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service. + Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few. + Generous paid time off to reenergize. + Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees. + Employee recognition program to celebrate anniversaries, team accomplishments, and more. For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement. + Commuter perks make your trip to work less impactful on the environment and your wallet. + Free convenient on-site parking. + Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable. + Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more. + Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling. + Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus. **Equal employment** **opportunity/affirmative** **action:** Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law. If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785. **Premera is hiring in the following states, with some limitations based on role or city:** Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin _._ The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience. The salary range for this role is posted below; we generally target up to and around the midpoint of the range. **National Salary Range:** $78,000.00 - $122,200.00 **National Plus Salary Range:** $81,900.00 - $139,200.00 _*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska_ _._ We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions. At Premera, we make healthcare work better. By focusing on improving our customers’ experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives. As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services. Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.