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Pittsburgh, Pennsylvania, United States • Hybrid
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The role serves as a clinical subject matter expert to support the acquisition and retention of accounts through clinical analysis and strategic interventions. It involves collaborating with internal stakeholders and external clients to deliver data-driven clinical strategies and performance metrics.
Requires a Bachelor's degree in Nursing, Pharmacy, or a clinical field and at least 5 years of experience in a clinical or managed care setting. Candidates must hold a current RN, Physician Assistant, or Pharmacist license.
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. Provides and interprets client specific clinical data to facilitate the sale and implementation of optimal clinical interventions that deliver clinical and financial results. The incumbent is also expected to stay current on market trends, understand the competition, and assist the product, clinical, and analytic internal partners to execute on strategy. Represents the Organization as the subject matter expert for all clinical programs, products and recommendations to clients. Will assist with team development through mentoring, training and education.
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.
Develop and manage positive and effective relationships with key internal and external partners and decision makers including sales, product, provider, quality, clinical, pharmacy, partner plans, consulting firms, and third-party vendors. 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. Articulate the ‘so what’ to the customer by alignment of analytics and performance metrics to track quantitative clinical and financial results, and communicating value and progress for clients which contributes to sales and retention.
In coordination with Sales, strategize to develop and implement data-driven, clinical intervention plans and strategies for the Organization's clients to effectively impact behavior change, risk, medical costs and productivity impairment.
Research and stay current on health, wellness, productivity, risk and care management trends in the market place 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.
Participate in departmental strategic planning, goal setting and strategic initiative coordination and lead the portion associated with the Clinical Strategy Consultants. Responsible for identifying and completing a process improvement project at least annually in conjunction with Clinical Strategy leadership team.
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
Substitutions
None
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
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)
Preferred
None
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
Travel Requirement:
25% - 50%
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
Never
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
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Our mission is to create a remarkable health experience, freeing people to be their best.
Allegheny Health Network is an integrated health care delivery system serving the greater Western Pennsylvania region. More than 2,600 physicians and 21,000 employees serve the system's 16 hospitals as well as its ambulatory medical and surgery centers, Health + Wellness Pavilions, and hundreds of physician practice locations. AHN is a proud part of Highmark Health.
Offices: 4800 Friendship Ave, Pittsburgh, Pennsylvania 15224, US · 2570 Haymaker Rd, Monroeville, Pennsylvania 15146, US · 320 E North Ave, Pittsburgh, Pennsylvania 15212, US · 12351 Perry Hwy, Wexford, Pennsylvania 15090, US · 1301 Carlisle St, Natrona Heights, Pennsylvania 15065, US
Based on 229 listings with disclosed salaries, most consulting jobs in Pittsburgh, PA pay between $55k–$170k per year. Individual offers vary with seniority, company size, and specialization.
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