Sr Clinical Consultant

Point32Health; Canton (MA); Hybrid; USD 109,730 - 164,595; Full time

Benefits offered by this job

Health benefits

Retirement plans

Paid time off

Life and disability insurance

Tuition program

Well-being benefits

Job summary

Point32Health is seeking a Senior Clinical Consultant in Canton, MA. You will coordinate clinical service issues, prepare performance presentations, and analyze data to drive improvement.

You’ll support escalated client requests and underwriting with clinical content, while collaborating with internal teams and the Medical Director. The role requires strong independent work and the ability to balance multiple complex issues with sound judgment.

Qualifications

• Current Registered Nurse state license.
• Associate’s degree in nursing or BSN (required).
• Master’s degree; MPH very desirable (preferred).
• 5–7 years of clinical nursing experience (required).
• Second-language proficiency highly desirable.

Responsibilities

• Coordinate clinical service issues and present high‑quality performance reviews.
• Analyze data, develop strategies and programs for performance improvement.
• Support escalated client requests and underwriting with clinical content.
• Collaborate with Medical Director and other departments on provider relationships.
• Provide training on resources and problem resolution paths.
• Travel to employer sites as required.

Skills

Clinical nursing

Data analysis

Presentation skills

Communication

Autonomy

Project management

Problem solving

Education

Associate’s degree in nursing

BSN

Master’s degree; MPH desirable

Tools

Excel

Word

PowerPoint

Visio

Job description

We are a leading not‑for‑profit health and well‑being organization dedicated to delivering high‑quality, affordable healthcare to nearly 2 million members. We build on a strong legacy and a culture of shared values and inclusion.

Job Summary

The Senior Clinical Consultant will serve as the liaison for all clinical service issues, coordinating, producing, and presenting high‑quality presentations for performance reviews, conducting clinical analysis, designing and implementing strategies and programs, and providing support for escalated client requests and underwriting. The role requires strong independent and collaborative work.

Key Responsibilities

• Employer Performance and Clinical Content
  • Utilize cost, quality and utilization reports and collaborate with other departments to analyze data and metrics, and effectively communicate clinically relevant material.
  • Help develop performance‑review presentations and review performance metrics on an ongoing basis.
  • Identify and coordinate clinical strategies to address plan performance concerns and serve as a resource for clinical content on the portal.
  • Assist with recommendations and implementation with the team.
• Provide daily support for resolution of escalated issues or questions
  • Collaborate with internal departments to research and provide responses.
  • Implement training on company resources and alternative paths for problem resolution.
  • Redirect to other Point32Health key contacts.
• Account Clinical Performance Guarantees
  • Develop clinical performance guarantees with other departments.
  • Track guarantees and intervene if not met.
• Assist with Provider Relationships
  • Work with the Medical Director to establish provider relationships.
  • Develop and implement provider collaborations and coordinate with other departments.
  • Participate in provider meetings and collaborate with Provider Performance, Provider Contracting and Quality teams.
• Other selected activities to support the department, division and organization.
• Other projects and duties as assigned.

Qualifications

• Certification and Licensure
  • Current Registered Nurse state license.
• Education
  • Associate’s degree in nursing or BSN (required).
  • Master’s degree; MPH very desirable (preferred).
• Experience
  • 5–7 years of clinical nursing experience (required).
  • Patient education experience desirable (preferred).
• Skill Requirements
  • Second‑language proficiency highly desirable.
  • Worksite wellness consultation desirable.
  • Excellent verbal, written and presentation skills.
  • Ability to analyze complex data.
  • Flexibility to address multiple complex issues and make sound judgment.
  • Strong clinical and critical‑thinking abilities.
  • Project or program management experience and business writing skills.
  • Proficiency in Excel, Word, PowerPoint and Visio.
  • Ability to work autonomously.
  • Influencing and partnership‑building skills.
  • Commitment to excellence in customer service.
• Working Conditions
  • Frequent travel to employer sites.
  • Work under normal office conditions and may work from home when required.
  • Simultaneous use of telephone/headset and PC/keyboard while sitting for extended durations.
  • May be required to work additional hours beyond the standard schedule.

Salary Range

$109,730.00 – $164,595.00

Benefits

• Medical, dental and vision coverage
• Retirement plans
• Paid time off
• Employer‑paid life and disability insurance with additional buy‑up coverage options
• Tuition program
• Well‑being benefits
• Full suite of benefits to support career development, individual & family health, and financial health

All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.