Clinical Strategy Consultant - Remote/Hybrid (Camp Hill and Philadelphia area)

About the Role

This position supports the acquisition of new accounts and retention of existing accounts by working directly with client managers within national and regional markets. The incumbent is primarily accountable for delivering clinical analysis and strategies for Highmark customers, including healthcare consultants and brokers. Provides and interprets client-specific clinical data to facilitate the sale and implementation of optimal clinical interventions that deliver clinical and financial results. The role involves staying current on market trends, understanding the competition, and assisting internal partners in product, clinical, and analytic teams to execute strategy. The incumbent will serve as the subject matter expert for all clinical programs, products, and recommendations to clients and will assist with team development through mentoring, training, and education.

Responsibilities

• Serve as the clinical subject matter expert for clinical, quality, care, utilization, high-cost claim, and population health management during presentations with external clients, brokers/producers, and new prospects.
• Develop strategies to support the acquisition and renewal of membership; prepare for and provide a clinical perspective on discussions; share clinical and operational insights with internal stakeholders after customer interactions.
• Participate in ad-hoc and annual clinical review meetings to provide health and wellness perspectives; share broad clinical insights with internal stakeholders and accounts.
• Develop and manage positive, effective relationships with key internal and external partners, including sales, product, provider, quality, clinical, pharmacy, partner plans, consulting firms, and third-party vendors.
• Stay current with market trends, client cultures, and industry changes to support behavior change, improve value propositions, and execute core clinical principles and programs.
• Collaborate with Clinical Strategy Analysts to create and deliver relevant metrics, clinical reports, and quarterly/annual outcomes for all clinical strategies across current and emerging care models.
• Articulate the value of analytics and performance metrics to clients, aligning them with quantitative clinical and financial results to demonstrate progress and contribute to sales and retention.
• Coordinate with Sales to develop and implement data-driven clinical intervention plans and strategies that impact behavior change, risk, medical costs, and productivity impairment.
• Research and stay updated on health, wellness, productivity, risk, and care management trends; share insights and best practices in sales discussions; attend conferences and contribute to publications as needed.
• Coordinate post-sale and ongoing aspects of clinical product implementation and outcomes with senior-level executives at the client level, external vendors, and brokers.
• Track, communicate, and implement best practices and industry-specific successes and challenges across all markets.
• Participate in departmental strategic planning, goal setting, and strategic initiative coordination; lead initiatives associated with Clinical Strategy Consultants.
• Identify and complete at least one process improvement project annually in conjunction with the Clinical Strategy leadership team.
• Serve as the primary client contact for clinical-related issues or questions; participate in internal groups as a subject matter expert.
• Provide appropriate content and consultation to support the RFP/RFI process.
• Perform other duties as assigned or requested.

Requirements

• Bachelor’s Degree in Nursing, Pharmacy, Physician Assistant, or a clinical field (Required).
• Master’s Degree in Business or a clinical field (Preferred).
• 5 years of experience in a Clinical or Managed Care setting (Required).
• 3 years of Client Sales Support experience (Preferred).
• 3 years of external client-facing experience (Preferred).

Qualifications

• Current State RN licensure or current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or Physician Assistant License or Pharmacist (PharmD) license (Required).

Skills

• Critical thinking and effective problem-solving and decision-making skills.
• Understanding of key clinical concepts.
• Excellent interpersonal, presentation, communication, and listening skills.
• Strong business acumen.
• Demonstrated effective presentation delivery.
• Conflict and crisis management skills.

Schedule

• Office-based position.
• Travel requirement: 25% - 50%.
• Occasional teaching/training of others.
• Regular travel from the office to various work sites or site-to-site.

Physical and Mental Demands

• Lifting up to 10 pounds: Constantly.
• Lifting 10 to 25 pounds: Occasionally.
• Lifting 25 to 50 pounds: Never.