Clinical Performance Consultant
Job Description Job Description Clinical Performance Consultant Job Description About Company: About Advanced Management USA At Advanced Management USA, we are not just transforming healthcare—we are building careers that make a lasting impact. Established in 2017, we empower physicians and healthcare providers through innovative value-based care strategies, ensuring better patient outcomes while driving efficiency. Why Join Us? We are a fast-growing, forward-thinking company that values innovation, collaboration, and excellence. At Advanced Management USA, you will: Make an Impact – Be part of a team that improves healthcare delivery and patient care. Grow Your Career – We offer mentorship, leadership training, and career advancement opportunities. Work in a Supportive Environment – We foster an inclusive workplace culture where employees are encouraged to learn and thrive. Work with Cutting-Edge Technology – Access the latest healthcare solutions to drive real results. Our Vision and Values We envision a future where healthcare providers lead the way in care coordination, driving better patient experiences, improved population health, and greater healthcare value. Our values guide everything we do: Patient-Centric Care – Always prioritizing the patient’s needs. Data-Driven Decisions – Using analytics to improve healthcare strategies. Supportive Resources – Providing advanced technology and expert consulting for healthcare providers. Join Our Team If you’re looking for a career where you can grow, innovate, and make a difference in healthcare, Advanced Management USA is the place for you. We are always looking for motivated professionals to join our team and contribute to our mission. About the Role: We are hiring an Clinical Performance Consultant to support practices participating in our LEAD Model ACO (Accountable Care Organization). This field-based clinical role combines complex case management, HCC/risk adjustment expertise, provider education, care coordination, and social needs intervention. The primary focus is identifying high-risk and high-needs Medicare beneficiaries and coordinating the clinical, social, and community-based resources necessary to help patients remain safely in their homes and avoid preventable emergency department visits, hospitalizations, and institutional care. The Consultant serves as a bridge between the patient and caregiver, primary care practice, ACO care management resources, and community partners. The ideal candidate is a clinically trained professional with experience in case management and HCC/risk-adjustment documentation, who can communicate effectively with both providers and patients and is comfortable working in the community. Essential Duties and Responsibilities Complex Care Management & Keeping Patients at Home Identify high-risk, high-needs, and medically complex patients who may benefit from additional intervention. Conduct patient and caregiver outreach. Assess barriers that may contribute to avoidable emergency department visits, hospitalizations, or inability to remain safely at home. Evaluate clinical, functional, medication, transportation, caregiver, food, housing, and other social needs affecting the patient's ability to manage their health. Develop individualized intervention plans in collaboration with the patient, caregiver, primary care provider, and care team. Coordinate services and resources including primary care, specialists, home health, DME, pharmacy, transportation, community organizations, and other available support services. Identify changes in condition or unmet needs requiring provider intervention and communicate concerns promptly to the appropriate clinical team. Support patients following hospitalizations and emergency department visits to ensure appropriate follow-up and continuity of care. Assist patients and caregivers in understanding care plans, medications, appointments, and available community resources. Follow up on interventions to ensure that identified needs were actually addressed and services were successfully connected. Identify recurring barriers or utilization patterns and recommend interventions to the care team and participating practices. Help practices and care teams identify opportunities to intervene earlier in the patient's disease progression rather than responding after an avoidable acute event. HCC / Risk Adjustment & Provider Education Review HCC suspect and recapture opportunities with participating practices. Educate providers and clinical staff regarding HCC documentation requirements, including specificity, MEAT criteria, and annual recapture requirements. Review patient records and identify chronic conditions that may require assessment, treatment, monitoring, or additional documentation. Work with providers to incorporate appropriate chronic-condition assessments and documentation into routine patient visits. Help providers understand the clinical significance of appropriately identifying and documenting chronic conditions. Collaborate with practice staff to address missed HCC recapture opportunities and improve documentation workflows. Provide feedback regarding recurring documentation gaps and opportunities for improvement. Partner with practices to integrate HCC identification into pre-visit planning, annual wellness visits, chronic care management, transitional care management, and other appropriate workflows. Provider & Practice Engagement Serve as a clinical point of contact for assigned practices. Review high-risk patient populations, care gaps, utilization trends, and care-management opportunities with practice teams. Translate reports and patient-level data into actionable interventions. Help practices identify patients who would benefit from additional care management or community-based support. Educate providers and staff about available ACO care management services and community resources. Establish strong working relationships with physicians, advanced practice providers, nurses, care coordinators, and office staff. Document discussions, interventions, action plans, and outcomes. Escalate patients or practices requiring additional clinical or operational intervention. Social & Community Resource Coordination Identify social determinants of health and other non-clinical barriers affecting health outcomes. Connect patients and caregivers with appropriate community-based resources. Assist with coordination of resources related to transportation, food insecurity, caregiver support, housing, medication access, financial barriers, and other identified needs. Develop relationships with community organizations and service providers within the assigned market. Identify gaps in available community resources and communicate those needs to ACO leadership. Support patients in navigating available services rather than simply providing a resource list. LEAD / ACO Responsibilities Support participating practices with LEAD Model care management and quality initiatives. Support pre-visit planning, annual wellness visits, chronic care management, transitional care management, and other value-based care workflows. Support beneficiary alignment workflows as appropriate. Monitor assigned patient and practice-level performance data. Identify patients and practices at increased risk for poor outcomes and recommend appropriate interventions. Track care management activities, patient outcomes, referrals, and closed-loop interventions. Support efforts to reduce avoidable emergency department utilization and hospital admissions. Participate in onboarding and education for new participating practices. Maintain accurate documentation in Care Compass and other applicable systems. Abide by all HIPAA, confidentiality, and privacy requirements. Minimum Qualifications: Bachelor’s degree in Nursing. Minimum of 3 years of experience in clinical performance improvement, quality management, or healthcare consulting. Strong knowledge of clinical workflows, healthcare regulations, and quality improvement methodologies. Proficiency in data analysis and performance measurement tools. Excellent communication and interpersonal skills to effectively engage with diverse clinical teams. Abiity to work independentlu in a field-based environment. Ability to assess patient needs and develop practical interventions. Proficiency with Microsofte Excel, Word, and PowerPoint. Valid driver's license and reliable transportation. Ability to travel throughout the assigned market and conduct community/home-based activities as required. Preferred Qualifications: HCC/risk-adjustment coding or documentation experience. Experience educating providers on HCC documentation, MEAT criteria, and annual recapture. Experience with Medicare Advantage, ACOs, value-based care, or CMMI models. Experience with transitional care management or post-discharge follow-up. Home health, community health, or home-based care experience. Experience working with high-needs, dually eligible, or medically complex populations. Familiarity with social determinants of health and community resource navigation. Bilingual English/Spanish. Experience using care management, population-health, or EHR platforms. Experience working within large healthcare systems or hospitals. Familiarity with electronic health record (EHR) systems and clinical informatics. Demonstrated success in leading multidisciplinary clinical improvement projects. Key Performance Measures Success in this role should be measured not only by provider engagement and HCC recapture, but by the ability to change patient outcomes and close the loop on identified needs. Potential measures include: High-risk patients successfully engaged in care management Completed patient/home assessments Closed-loop community resource referrals Successful post-discharge follow-up Avoidable ED visits and hospitalizations Patients successfully connected to appropriate home/community services Care gaps closed Appropriate HCC recapture/documentation improvement Provider education and engagement Medication and care-plan barriers resolved Patient/caregiver needs identified and addressed Successful interventions that support patients remaining safely at home Position Philosophy The goal of this position is not simply to identify what is missing from a patient's chart. The goal is to identify what is missing from the patient's care and take action. HCC documentation, care gaps, utilization data, patient outreach, home assessments, provider education, and community resources should work together to identify patients who are at risk and intervene before their needs result in an emergency department visit, hospitalization, or loss of independence at home. Skills: The Clinical Performance Consultant utilizes analytical skills daily to interpret complex clinical data and identify performance trends that inform improvement strategies. Strong communication skills are essential for collaborating with clinical staff and leadership to foster a culture of quality and safety. Project management abilities enable the consultant to design, implement, and monitor improvement initiatives effectively. Knowledge of healthcare regulations and quality standards ensures that all recommendations comply with legal and accreditation requirements. Additionally, proficiency with data visualization and reporting tools supports clear presentation of findings and progress to stakeholders, facilitating informed decision-making and sustained clinical excellence.
