Clinical Consultant

Hearst•Tampa, FL

About The Position

The Clinical Consultant is a senior clinical and operational expert with deep experience across the integrated spectrum of Care Management services, including Care Management (CM), Utilization Management (UM) and Complaints, Appeals & Grievances (CAG). This role advises health plan and payer executives on implementing best-practice workflows that strengthen compliance, improve health outcomes, and drive meaningful operational efficiency. Serving as a trusted partner across the client lifecycle, the Clinical Consultant brings strategic insight into aligning CM, UM, and CAG functions to support whole-person care, drive quality outcomes, and ensure seamless coordination across clinical touchpoints.

Requirements

5+ years in clinical consulting, healthcare technology, or solution implementation preferred.
Strong knowledge of regulatory requirements, payer workflows, and clinical quality programs (HEDIS, Stars preferred).
Proven ability to influence senior stakeholders, lead complex engagements, and drive measurable operational improvements.
Exceptional communication, facilitation, and problem-solving skills.
Bachelor’s Degree in Nursing or Healthcare
Licensed clinician preferred (RN, RPh, or equivalent) with deep experience in Care Management, UM, and CAG.
Demonstrated alignment with MHK’s values of Integrity, Client Focus, Ownership, Collaboration, and Continuous Improvement.
Willingness to travel up to 20%
All prospective candidates must be able to pass a pre-employment background check and drug screening.

Responsibilities

Advisory & Implementation Leadership Lead executive and operational discussions to assess current Care Management, UM, and CAG workflows and define future-state best practices.
Direct discovery sessions, requirements documentation, and identification of automation and efficiency opportunities.
Serve as the clinical authority throughout implementation, guiding data mapping, integrations, regulatory reporting, and workflow design.
Proactively identify risks, advise on issue resolution, and ensure alignment with compliance, quality, and operational objectives.
Ensure transparency in communication and deliverables to reinforce trust and credibility.
Client Enablement & Optimization Provide expert guidance on system functionality, workflow validation, testing, and defect triage.
Conduct health checks, benchmarking, and performance reviews to ensure clients maximize automation, accuracy, and outcomes.
Recommend targeted workflow improvements, configuration changes, and integration enhancements to strengthen efficiency and user experience.
Educate clients on regulatory intent and operational impacts, simplifying complex requirements into actionable steps.
Continue to build and grow client trust organically as a clinical advisor by proving an ongoing value through accountability, proactive communication and transparency, while providing tailored solutions aligned to each client’s goals and use cases.
Growth & Product Influence Support Sales through advanced clinical discovery, process analysis, and CareProminence demonstrations.
Contribute clinical expertise to RFP responses and strategic solution recommendations.
Partner with Product and Development to surface enhancement opportunities and shape roadmap priorities based on real-world clinical and operational needs.