Clinical Account Manager - HCA

Cambia Health Solutions • Renton, WA

20d • Hybrid

About The Position

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Every day, Cambia’s dedicated team of Clinical Account Managers are living our mission to make health care easier and lives better. As a member of the HCA team, our Clinical Account Manager serves as a strategic clinical liaison for one of our largest customer groups, collaborating across internal teams to evaluate, present, and implement clinical programs and solutions that align with the customer's multiyear business strategy. This role provides ongoing consultative support by leveraging clinical expertise and data insights to recommend care management solutions that improve member health outcomes and productivity while meeting customer objectives – all in service of creating a person-focused health care experience.

Requirements

• Clinical license required (e.g., Licensed Practical Nurse or Registered Nurse)
• Bachelor's degree in Healthcare, Business or related field (MPH, MHA or MBA preferred)
• 8 years of case management, utilization management, or behavioral case management, including program management, sales or consulting experience, or equivalent combination of education and experience.
• Proven ability to develop and maintain strategic account relationships with customers and internal stakeholders, serving as a proactive, consultative partner who advances customer goals while aligning with health plan business strategies
• Demonstrated experience leading collaborative strategic planning, creating financial business cases, and ensuring successful operational execution of clinical programs
• Strong communication and presentation skills with the ability to influence, advocate, and unite colleagues to achieve customer objectives
• Knowledge of health insurance industry trends, clinical case management, utilization management practices, and regulatory requirements (CMS, state, HEDIS)
• Ability to evaluate program effectiveness, identify opportunities for improvement, and manage multiple projects within time constraints
• Strong data analysis skills with the ability to abstract, interpret, and translate complex data into actionable plans and solutions

Nice To Haves

• Experience with AI tools and technologies to enhance productivity and decision-making highly desired

Responsibilities

• Ensures clear understanding of client clinical needs and proactively recommends strategies, programs, and contingency plans to achieve business objectives while anticipating potential obstacles
• Displays an enthusiastic, self-directed approach while leveraging internal resources (Provider Network Management, Healthcare Services, Underwriting) and developing strong relationships with key stakeholders and vendors
• Monitors business/industry conditions, customer developments, and competitive activities to stay ahead of market trends
• Ensures alignment of systems and end-to-end processes to support new programs and optimize outcomes and member experience
• Collaborates with internal and external partners on collection, analysis, and maintenance of clinical data, partnering with Healthcare Informatics to meet market needs
• Analyzes and effectively presents clinical data to customers, providing consulting to improve health plan performance
• Collaborates with internal program contacts, external resources, and customers to test, develop, and implement clinical programs while resolving design and implementation challenges

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior