Clinical Program Consultant or Sr DOE

Cambia Health Solutions; Seattle (WA); Remote; USD 80,000 - 132,000; Full time

Job summary

A leading nonprofit health care organization seeks a Clinical Program Consultant to enhance health plan performance and drive program improvement. The role involves analytical assessments, engaging presentations, and collaboration across teams to deliver high-quality clinical programs that support client health and well-being.

Benefits

401(k) match

Medical, dental, and vision coverage

Paid parental leave

Annual employer contribution to a health savings account

Up to 12 weeks of paid time off

Furniture and equipment allowance for remote work

Qualifications

• Possesses a clinical license (e.g., Registered Nurse).
• 5-7 years experience in case management or consulting.
• Strong understanding of healthcare regulatory requirements.

Responsibilities

• Utilizes clinical knowledge for health plan performance reporting.
• Educates and trains leadership on clinical programs.
• Conducts clinical claims analysis to understand healthcare trends.

Skills

Clinical analysis

Communication

Data presentation

Problem-solving

Education

Bachelor’s degree in Healthcare, Business, or related field

Master’s degree (MPH, MHA, or MBA preferred)

Job description

Remote in ID, UT, WA, OR. Candidates outside of these states will not be considered.

Travel will be required locally and out of state.

Primary Job Purpose

Utilizes clinical knowledge learned from diverse clinical work experiences such as clinical nursing, care management experience and/or employee benefit consulting exposure to develop, inform and consult with others regarding health plan performance reporting and clinical programs for clients/customers and/or offer appropriate recommendations to support memberships health and wellbeing.

Collaborates with Clinical Services staff, departments across the organization, and/or external partners for various needs such as learning about program deliverables and obtaining informatics to develop recommendations which may be provided in written documentation and which may be included in the development of internal or external facing presentations.

Provides education, training, or analysis related to care management and/or utilization management programs to enhance program quality, value and cost effectiveness, May conduct clinical claims analysis on cost and utilization patterns to help employer clients or internal departments understand trends and causes of healthcare expenditures.

The Senior Clinical Program Consultant regularly provides consultative clinical support to external audiences such as provider partners, brokers, customer accounts or prospective accounts. Develops and presents clinical content and uses data to recommend clinical programs and services that align with customer strategy and drive adoption and growth of product offerings.

General Functions and Outcomes

Skilled at analysis of health plan informatics including utilization patterns and drivers of health care expense.

Possesses strong communication skills in the presentation of clinical data findings in an easy to digest manner that informs external customers and advises on how to improve their health plan performance.

Engaged in continuous learning about Regence operated clinical programs, programs embedded for fully insured members and buy-up options for self-funded groups and their value proposition.

Educates and trains leadership, colleagues, and business associates regarding clinical programs, their elements and its value proposition with an understanding of implementation objectives and procedures.

Effectively communicates orally and in written form an overview of applicable clinical programs and services offered as part of existing employer client, broker or prospective account presentations.

Collaborates effectively with leadership, the internal Clinical Consulting team, Sales, Informatics and other internal departments in an effort to gain knowledge, to problem solve, to enhance program delivery and to present findings to appropriate parties whether internal or external.

Conducts research and root cause analysis on member, provider, vendor or process issues and effectively communicates clinical and process findings to key stakeholders.

In conjunction with internal leadership develops monitoring and control procedures to improve work initiatives that informs operational achievements and tracks opportunities for improvement.

Collaborates with internal and external business partners on the collection, analysis, and maintenance of relevant data.

Provides leadership and operational oversight for all or assigned aspects of job duties and results from performance of self and the team with plan to drive towards continuous improvement.

Monitors results and metrics to ensure deliverables are met in compliance with department and regulatory standards.

Additional General Functions and Outcomes for Clinical Program Consultant Senior

Effectively collaborates with internal program contacts and/or external resources to test and develop programs and offer support to resolve implementation, compliance, and program design challenges.

Utilizes clinical expertise and judgement to ensure compliance with program design, contractual requirements, accreditation standards and accepted standards of care.

Ability to evaluate program effectiveness, identify issues and opportunities, and work to continuously improve programs offered.

Strong communication and presentation skills including public speaking of presenting clinical data findings in an easy to digest manner that informs and advises to among groups of diverse stakeholders.

Ability to resolve issues with diplomacy and persuasiveness and build consensus among groups of diverse stakeholders.

Knowledge of health insurance industry trends and technology.

Ability to analyze and objectively interpret health plan metrics that informs and guides appropriate next best action.

Experience in areas of clinical case management and utilization management practices.

Knowledge of healthcare regulatory requirements and HEDIS

Ability to organize, plan, prioritize and develop multiple projects within time constraints.

Clinical license (e.g. Registered Nurse).

Normally to be proficient in the competencies listed above:

Clinical Program Consultant would have a clinical license, Bachelor’s degree in Healthcare, Business or related field (MPH, MHA or MBA preferred) and a 5 years of case management, utilization management, or behavioral case management or equivalent combination of education and experience. Preferably, has experience in a variety of health care fields beyond CM/UM such as direct clinical care and consulting experience.

Clinical Program Consultant Senior would have a clinical license, Bachelor’s degree in Healthcare, Business or related field (MPH, MHA or MBA preferred) and 7 years of case management, utilization management, or behavioral case management, including sales or consulting experience, or equivalent combination of education and experience. Preferably, has experience in a variety of health care fields beyond CM/UM such as direct clinical care and consulting experience and held prior leadership roles.

#LI-remote

The expected hiring range for a Clinical Program Consultant is $80,500 - $109,500 and for a Clinical Program Consultant Senior is $97,000 - $132,000 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for the Clinical Program Consultant role is 10% and 15% for the Clinical Program Consultant Senior role. The current full salary range is $76,000 - $123,500 for the Clinical Program Consultant and is $91,500 - $149,000 for the Clinical Program Consultant Senior.

Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

medical, dental, and vision coverage for employees and their eligible family members

annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)

paid time off varying by role and tenure in addition to 10 company holidays

up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)

up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)

one-time furniture and equipment allowance for employees working from home

up to $225 in Amazon gift cards for participating in various well-being activities. for a complete list see our External Total Rewards page.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email [e-mail] . Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy . As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

About the company

Cambia Health Solutions is a nonprofit health care company based in Portland, Oregon.

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