Clinical Account Manager - HCA

About the role

Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.

Responsibilities

• Develops and maintains 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.
• Led collaborative strategic planning, creating financial business cases, and ensuring successful operational execution of clinical programs.
• Communicates and presents clinical expertise to customers, providing consulting to improve health plan performance.
• Collaborates with internal and external partners on collection, analysis, and maintenance of clinical data, partnering with Healthcare Informatics to meet market needs.
• Tests, develops, and implements clinical programs while resolving design and implementation challenges.

Requirements

• Has a clinical license (licensed practical nurse or registered nurse).
• Has a Bachelor's degree in Healthcare, Business or related field (MPH, MHA or MBA preferred) and 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.

Qualifications

• 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.

Skills and Attributes

• 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.
• 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.
• 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.

Pay

The expected hiring range for the Clinical Account Manager - HCA is $101,200 - $115,000 depending on skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. The bonus target for this position is 15%. The current full salary range for this role is $95,000 - $155,000.

Schedule

Work from home options for most of our roles are available. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.