Sr Clinical Consultant

Point32Health • Canton, MA

9d • Hybrid

About The Position

The Senior Clinical Consultant will perform in various roles focusing on clinical opportunities for members, providers, and employers. The Senior Clinical Consultant will be the liaison for all clinical service issues. This position assists in coordinating, producing, and presenting high quality presentations for performance reviews. This includes gathering metrics, data, and other pertinent information from all relative departments and conducting a clinical analysis to communicate trends and other clinically related information. The position requires understanding each unique population, their priorities, and needs. Working within the clinical strategies, collaborates with stakeholders and departments to design and implement strategies and programs to address these needs and priorities. In addition, this role will assist with support and providing responses resulting from escalated client requests. This role also supports internal functional areas such as underwriting to provide clinical support on various matters. Critical to this role's success is the ability to demonstrate strength working independently and collaboratively within the team environment.

Requirements

• Current Registered Nurse state license
• Associate's degree in nursing or BSN
• 5 – 7 years of clinical nursing experience
• Proficiency in a second language is also highly desirable
• Worksite Wellness consultation desirable
• Excellent verbal and written communication, active listening skills, and high-level presentation skills
• Ability to analyze and comprehend complex data
• Address multiple complex issues throughout the workday in a flexible professional manner.
• Requires initiative, sound judgment, and the ability to work under pressure in a constantly changing environment balancing multiple priorities and utilizing resources aggressively.
• Must be able to exercise appropriate judgment as necessary and raise issues to the appropriate level.
• Demonstrate strong clinical and critical thinking abilities; able to synthesize timely updates based on Point32Health Business needs and current events in the community.
• Requires excellent web and business writing skills as well as project or program management experience.
• Strong computer skills required including proficiency in Excel, Word, PowerPoint, and Visio.
• Ability to perform job functions with autonomy.
• Influencing others and ability to quickly build partnerships particularly those outside of direct reporting relationships.
• Ability to synthesize and present complex information.
• Must be self-directing, politically astute and have outstanding interpersonal, teaching, decision-making and presentation skills.
• Must have commitment to excellence in customer service.

Nice To Haves

• Master’s degree; MPH very desirable
• Patient education experience desirable

Responsibilities

• Utilizing cost, quality and utilization reports, and discussion with team, the Sr. Relationship Clinical Consultant will work in conjunction with other departments as needed
• Analyzes data and metrics from a variety of departments and sources to effectively communicate with groups clinically related material related to their plan’s performance
• Works collaboratively with the team to develop the performance review presentations
• On an ongoing basis reviews data related to performance metrics and alerts on any issues or concerns related to clinical performance
• Identifies and coordinates clinical strategies to assist with addressing any plan performance concerns
• Serves as a resource for issues related to clinical content on the portal
• In collaboration with team assists with the development of recommendations and works with the team to implement
• Provides daily support to resolution of escalated issues or questions
• Collaborates with internal departments to research and provide a response
• Implements training on company resources and alternative paths for problem resolution
• Redirects to other Point32Health key points of contact
• Works in collaboration with other departments to develop clinical performance guarantees
• Ensures processes are in place to track clinical performance guarantees related to applicable accounts and intervenes as needed if guarantees are not being met
• Jointly works with the Medical Director to establish provider relationships as needed
• Assists with the development and implementation of provider collaborations and oversees coordination requiring other departments within the organization
• Participates in and assists with provider meetings
• Works in collaboration with Provider Performance, Provider Contracting and Quality teams as necessary
• May be asked to participate in functions and activities other than the above in supports of the department, division, and organization as Pont32Health continues as the organization of Point32Health continues to develop
• Other projects and duties as assigned.

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

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: Associate degree