Clinical Solutions Specialist - General Medicine

Upward Health • Phoenix, AZ

46d • Remote

About The Position

The Clinical Solution Specialist is responsible for the design, implementation, and evaluation of clinical care solutions that improve patient outcomes, support value-based care initiatives, and align with organizational goals. This role serves as a subject matter expert bridging clinical expertise and operational strategy, working closely with cross-functional teams including clinical operations, quality, technology, and business development. The Specialist brings deep knowledge of adult care delivery models and leverages data to inform the creation of scalable, patient-centered solutions across care settings.
This role works alongside doctors, nurses, social workers, nurse practitioners, and clinical services leaders to develop evidence-based clinical solutions, quality improvement strategies, patient care models, health risk mitigation approaches, and cross-functional workflows that are clinically sound, operationally feasible, and aligned to adult population needs.
The ideal candidate will have deep experience building adult clinical solutions, particularly within General Medicine, Primary Care, chronic condition management, and Clinical Triage. This includes creating workflows that support provider practice operations, nursing-led chronic condition care planning, patient assessments, care coordination, medication and adherence support, and escalation pathways for acute or emerging patient needs.
The Clinical Solution Specialist will also bring strong knowledge of transitions of care and readmission avoidance, including workflows for engaging patients during admission and discharge, completing discharge assessments, coordinating timely provider follow-up, supporting nursing-led transition planning, and helping care teams reduce avoidable emergency department visits, hospitalizations, and readmissions.

Requirements

• Nursing degree (BSN or higher preferred); RN license required
• Minimum 3 years of experience in clinical care delivery, care management, or clinical program design.
• Proficiency in project management tools and methodology
• Prior experience building adult care solutions and workflows
• Strong understanding of care delivery across diverse populations and settings (e.g., ambulatory, post-acute, home health, etc.)
• Familiarity with social determinants of health and how they impact patient care delivery
• Experience developing workflows and care models with clinical and non-clinical teams
• Proficiency in Electronic Medical Record (EMR) software and workflow documentation
• Clinical education and training experience (especially for nurses and care teams)
• Understanding of Medicare and Medicaid reimbursement structures
• Competent in Microsoft Office Suite and Visio for process design
• Experience in value-based care or population health strong preferred
• Expertise in designing pediatric and transitions of care workflows with a focus on reducing readmissions, enhancing care continuity, and improving family engagement.
• Detailed understanding of Provider / patient experience building and effective visit methods.
• Knowledge of problem identification and diagnosis code capture.
• Strong understanding of clinical care team collaboration to effectively provide whole-person care.
• Knowledge of chronic disease management techniques for nursing care planning and appropriate ties to the Provider’s plan of treatment.
• Knowledge of clinical triage principles to support timely assessment, prioritization, escalation, and resolution of acute patient needs.
• Understanding of nurse-led triage workflows, including symptom assessment, clinical decision support, provider escalation, and patient follow-up.
• Knowledge of transitions of care and readmission avoidance processes, including discharge follow-up, care coordination, medication-related concerns, and escalation of post-discharge risks.
• Proficiency in adult care and transition-related regulatory guidelines and quality standards (e.g., HEDIS, NCQA).
• Competence with Electronic Medical Records (EMR) systems and familiarity with healthcare-related software to enhance Solution delivery and data tracking.

Nice To Haves

• Project Management certification, lean six sigma, and/or other related certifications preferred
• Ability to travel to various Upward Health markets as needed
• Willingness to adjust to changing schedules and demands, including the flexibility to work occasional nights and weekends.
• Ability to analyze patient data to identify opportunities for solution enhancements.
• Familiar with project management tools and methodologies to plan, execute, and monitor the progress of clinical solution initiatives.
• Skilled in collecting, analyzing, and synthesizing clinical data, including health outcomes, patient satisfaction, and quality metrics.
• Proficient in creating actionable reports and presenting findings to leadership.

Responsibilities

• Design, implement, and evaluate clinical care solutions.
• Serve as a subject matter expert bridging clinical expertise and operational strategy.
• Work closely with cross-functional teams including clinical operations, quality, technology, and business development.
• Leverage data to inform the creation of scalable, patient-centered solutions across care settings.
• Develop evidence-based clinical solutions, quality improvement strategies, patient care models, health risk mitigation approaches, and cross-functional workflows.
• Create workflows that support provider practice operations, nursing-led chronic condition care planning, patient assessments, care coordination, medication and adherence support, and escalation pathways for acute or emerging patient needs.
• Develop workflows for engaging patients during admission and discharge, completing discharge assessments, coordinating timely provider follow-up, supporting nursing-led transition planning, and helping care teams reduce avoidable emergency department visits, hospitalizations, and readmissions.
• Collaborate with internal stakeholders (e.g., providers, care team members, quality teams, etc.) to ensure solutions are clinically sound and operationally viable.
• Actively listen to team members and stakeholders and integrate their feedback into Solution development.
• Use data analysis and clinical insights to inform decisions and develop effective solutions for improving Solution outcomes.
• Identify issues, assess risks, and implement corrective actions.
• Communicate complex clinical concepts clearly to both internal and external stakeholders.
• Influence care teams by presenting evidence-based rationales for workflow designs and updates.
• Demonstrate active listening and empathy, particularly in engaging with patients or healthcare professionals regarding behavioral health and substance use issues.
• Effectively present training materials and Solution updates to a variety of audiences, including patients, providers, and interdisciplinary teams.
• Adapt to changes in clinical solution needs, evolving best practices, regulatory or contractual requirements, or stakeholder expectations.
• Review medical records and clinical data with high attention to accuracy and compliance with regulations and standards (e.g., HEDIS measures, HIPAA).
• Ensure thorough documentation and synthesis of patient and solution data for reporting.
• Take ownership of the development and ongoing refinement of clinical solutions.
• Be responsible for meeting quality improvement metrics and patient outcomes associated with their solutions.
• Demonstrate leadership in clinical Solution training, ensuring all involved parties are educated on key aspects of the solution.
• Prioritize patient-centered care in the design of clinical solutions.
• Ensure that patient feedback and real-life outcomes are incorporated into the clinical solution’s evolution.
• Manage competing priorities and multiple stakeholder demands, ensuring deadlines are met and outcomes are achieved efficiently.
• Organize workflows and schedules for solution implementation, training, and assessment in an effective manner.
• Assess learning needs and collaborate effectively with clinical education team to build customized training solutions to diverse audiences.
• Create SOPs, job aids, and other materials to support the learning of care team members and at times, may participate in training.
• Lead the design and development of clinical solutions and care models that address patient needs across the care continuum.
• Translate clinical insights, evidence-based practices, and patient outcomes into actionable workflows and solution strategies.
• Analyze patient data to identify opportunities for solution enhancements.
• Develop and implement standardized workflows for developing primary and specialty care directories for more efficient patient resource support and navigation.
• Support the mapping, standardization, and improvement of clinical workflows across provider practices, triage pathways, chronic condition care planning, and transitions of care.
• Develop workflows that reduce unnecessary variation, handoffs, and bottlenecks while supporting appropriate clinical judgment, efficiency, and patient safety.
• Identify process gaps and recommend workflow improvements to support reliability, quality, and patient outcomes.
• Contribute to workflow designs that can be adapted across markets, technologies, and care delivery environments.
• Plan, execute, and monitor the progress of clinical solution initiatives.
• Coordinate timelines, resources, and stakeholder engagement to ensure the successful rollout of solutions.
• Collect, analyze, and synthesize clinical data, including health outcomes, patient satisfaction, and quality metrics.
• Create actionable reports and present findings to leadership.
• Design clinical solutions with consideration for how providers and care teams will adopt and sustain workflow changes.
• Identify potential adoption risks and incorporate practical considerations into workflow and solution design.
• Partner with operational and clinical leaders to support solutions that are executable and sustainable in real-world care settings.
• Support change efforts by helping care teams understand workflow updates, implementation expectations, and transition needs.
• Ensure audit readiness and documentation compliance across solutions.
• Utilize technology to improve solution outcomes and operational efficiency.
• Write in problem statement format to improve solutioning.

Benefits

• Upward Health Benefits

What This Job Offers

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