Clinical Account Consultant RN

About the role

The cornerstone of the CAC RN role is to serve as a direct liaison between BCBSF strategic accounts and the clinical component of the health plan. This position provides more direct, efficient, and effective clinical analysis of group-specific cost drivers and trends, identifying actionable opportunities and solutions targeted at existing and prospective cost drivers.

The role involves validating, analyzing, and interpreting information from highly technical business platforms (IT, Delivery, Service, Finance) to make effective cost, quality, and shared decision-making recommendations. This results in increased client satisfaction and retention. The position leverages problem-solving skills and frameworks to develop solutions to client business problems and supports both external and internal stakeholders through clinical analytics and decision support.

Responsibilities

• Validate, manipulate, analyze, and interpret information from highly technical areas to make effective cost, quality, and process decisions, developing client-specific initiatives that increase satisfaction, retention, and market competitiveness.
• Identify components of evolving healthcare strategies and opportunities through research and analysis, including healthcare industry assessments, predictive modeling, benchmarking, and competitor analyses.
• Translate corporate strategies into tactical applications within the strategic account arena.
• Manage multiple groups, complex issues, and projects simultaneously.
• Work collaboratively across cross-functional internal and external teams.
• Provide frameworks and processes to ensure consistency in decision-making.
• Prepare and deliver external client reports and presentations.
• Develop strong, trusted relationships with assigned groups, agents, consultants, and brokers to support retention.

Requirements

• 5+ years of related work experience, including clinical experience.
• Strong written and verbal communication skills.
• Experience with web-based tools, analytic platforms, and proficiency in Microsoft Office applications (Excel, PowerPoint).
• Related Bachelor’s degree or additional equivalent work experience (may substitute relevant experience for degree).
• Active RN (Registered Nurse) licensure in a state and/or compact state.
• CHC/PAHM certification within one year of employment.
• Experience in a matrix environment.
• Demonstrated communication and coordination skills managing multiple issues, including communications and planning.
• Proven ability to manage multiple complex business issues.
• Strong Care Management experience.
• Understanding of HIPAA regulations.
• Strong business and analytics skills.
• Customer-, member-, and sales-centric mindset.
• Strong demonstrated customer relations and relationship management skills.
• Occasional travel required.

Preferred Qualifications

• Critical thinking skills, strong work ethic, motivation, personal initiative, and maturity.
• Project management training or experience.
• 3+ years of account management experience.

Physical Demands

• Sedentary work: Exerting up to 10 pounds of force occasionally to move objects.
• Hybrid work arrangement combining flexibility with in-office engagement; team schedules determined by role requirements and business needs.
• Travel to and from corporate or regional offices may be required.

Benefits

• Medical, dental, vision, life, and global travel health insurance.
• Income protection benefits: life insurance, short- and long-term disability programs.
• Leave programs to support personal circumstances.
• Retirement Savings Plan with employer match.
• Paid time off, volunteer time off, 10 holidays, and 2 well-being days.
• Additional voluntary benefits available.
• Comprehensive wellness program.

Employee benefits align with federal and state employment laws and may vary based on work location. Benefits for interns, part-time, and seasonal employees may differ.

Pay

Annualized Salary Range: $84,500 - $137,300

Typical Annualized Hiring Range: $84,500 - $105,600

Final pay determined based on market competitiveness, internal equity, and job-related knowledge, skills, training, and experience.