Sr Clinical Consultant

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work.

Job Summary

The Senior Clinical Consultant will perform in various roles focusing on clinical opportunities for members, providers, and employers. The Senior Clinical Consultant will be the liaison for all clinical service issues. This position assists in coordinating, producing, and presenting high‑quality presentations for performance reviews. This includes gathering metrics, data, and other pertinent information from all relative departments and conducting a clinical analysis to communicate trends and other clinically related information. The position requires understanding each unique population, their priorities, and needs. Working within the clinical strategies, collaborates with stakeholders and departments to design and implement strategies and programs to address these needs and priorities. In addition, this role will assist with support and providing responses resulting from escalated client requests. This role also supports internal functional areas such as underwriting to provide clinical support on various matters. Critical to this role’s success is the ability to demonstrate strength working independently and collaboratively within the team environment.

Key Responsibilities

• Utilize cost, quality and utilization reports, and discussions with team; the Senior Relationship Clinical Consultant will work in conjunction with other departments as needed.
• Analyze data and metrics from a variety of departments and sources to effectively communicate clinically related material to groups regarding their plan’s performance.
• Work collaboratively with the team to develop performance review presentations.
• On an ongoing basis, review data related to performance metrics and alert on any issues or concerns related to clinical performance.
• Identify and coordinate clinical strategies to assist with addressing any plan performance concerns.
• Serve as a resource for issues related to clinical content on the portal.
• Assist with the development of recommendations and work with the team to implement them.
• Provide daily support to resolution of escalated issues or questions.
• Collaborate with internal departments to research and provide a response.
• Implement training on company resources and alternative paths for problem resolution.
• Redirect to other Point32Health key points of contact as necessary.
• Work in collaboration with other departments to develop clinical performance guarantees.
• Ensure processes are in place to track clinical performance guarantees related to applicable accounts and intervene as needed if guarantees are not being met.
• Assist with provider relationships by working with the Medical Director to establish provider relationships as needed.
• Assist with development and implementation of provider collaborations and oversee coordination requiring other departments within the organization.
• Participate in and assist with provider meetings.
• Work in collaboration with Provider Performance, Provider Contracting and Quality teams as necessary.
• Be prepared to participate in functions and activities other than the above in support of the department, division, and organization as Point32Health continues to develop.
• Complete other projects and duties as assigned.

Qualifications

• Certification and Licensure: Current Registered Nurse state license.
• Education: Associate’s degree in nursing or BSN required; Master’s degree or MPH very desirable.
• Experience: 5–7 years of clinical nursing experience required; patient education experience desirable.
• Skills: Proficiency in a second language highly desirable; worksite wellness consultation desirable.
• Excellent verbal and written communication, active listening, and high‑level presentation skills.
• Ability to analyze and comprehend complex data.
• Ability to address multiple complex issues throughout the workday in a flexible professional manner.
• Requires initiative, sound judgment, and ability to work under pressure in a constantly changing environment balancing multiple priorities and utilizing resources aggressively.
• Must be able to exercise appropriate judgment as necessary and raise issues to the appropriate level.
• Demonstrate strong clinical and critical thinking abilities; able to synthesize timely updates based on Point32Health Business needs and current events in the community.
• Excellent web and business writing skills and project or program management experience.
• Strong computer skills including proficiency in Excel, Word, PowerPoint, and Visio.
• Ability to perform job functions with autonomy.
• Influencing others and ability to quickly build partnerships particularly those outside of direct reporting relationships.
• Ability to synthesize and present complex information.
• Must be self‑directing, politically astute and have outstanding interpersonal, teaching, decision‑making and presentation skills.
• Commitment to excellence in customer service.

Working Conditions & Additional Requirements

There may be frequent travel to employer sites. Must be able to work under normal office conditions and work from home as required. Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations. May be required to work additional hours beyond standard work schedule.

Salary Range

$109,730.00 - $164,595.00

Compensation & Total Rewards Overview

The annual base salary range provided for this position represents a range of salaries for this role and similar roles across the organization. The actual salary for this position will be determined by several factors, including the scope and complexity of the role; the skills, education, training, credentials, and experience of the candidate; as well as internal equity. As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company’s sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

Benefits

Point32Health offers a competitive and comprehensive total rewards package which currently includes: Medical, dental and vision coverage; retirement plans; paid time off; employer‑paid life and disability insurance with additional buy‑up coverage options; tuition program; well‑being benefits; full suite of benefits to support career development, individual & family health, and financial health. For more details on our total rewards programs, visit

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Equal Employment Opportunity Statement

We welcome all applicants and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.