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

Job Summary

This job 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 the delivery of clinical analysis and strategies for Highmark customers, including healthcare consultants and brokers.

Essential Responsibilities

• Perform as the clinical subject matter expert for clinical, quality, care, utilization, high-cost claim and population health management as part of the clinical presentations with external clients, brokers/producers and new to blue prospects.
• Develop strategy to support acquisition and renewal of membership; prepare for and provide clinical perspective on clinically-related discussions as needed; provide clinical and operational insights back to internal stakeholders and accounts after customer discussions.
• Participate in ad-hoc and annual clinical review meetings as needed to provide clinical, health and wellness perspective; provides broad clinical insights back to internal stakeholders and accounts after customer discussion.
• Keep pace with fast-changing environment, client cultures and trends to better support behavior change by increasing senior level support, improving value proposition with a goal of focused interventions, creative strategies and execution of all core clinical principles and programs.
• Collaborate with Clinical Strategy Analysts to create a message and deliver relevant metrics and clinical reports as well as quarterly and annual outcomes and trends for all clinical strategies for all current and emerging care models.
• Research and stay current on health, wellness, productivity, risk and care management trends in the marketplace to share insights and best practices in sales discussions; attend conferences and contribute to publications as needed to support the clients, consultants, partners and centers of excellence function.
• Coordinate all 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 for all markets.
• Primary client contact for clinical related issues/questions. Participate in internal groups as needed, as a subject matter expert. Assist by providing appropriate content and consultation to support the RFP / RFI process.
• Other duties as assigned or requested.

Education

• Required: Bachelor's Degree in Nursing, Pharmacy, Physician Assistant or a clinical field
• Preferred: Master's Degree in Business or a clinical field

Experience

• Required: 5 years in a Clinical or Managed care setting
• PREFERRED: 3 years of Client Sales Support
• PREFERRED: 3 years of external client facing

Licenses or Certifications

• Required (any of the following): Current State RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC).
• Physician Assistant License
• Pharmacist (PharmD)

Skills

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

Language (Other Than English)

• None

Physical, Mental Demands and Working Conditions

• Position Type: Office-based
• Teaches / trains others regularly
• Occasionally Travel regularly from the office to various work sites or from site-to-site
• Rarely Works primarily out-of-the office selling products/services (sales employees)
• Never Physical work site required
• Yes Lifting up to 10 pounds
• Constantly Lifting 10 to 25 pounds
• Occasionally Lifting 25 to 50 pounds

Travel Requirement

• 25% - 50%

Disclaimer

The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org