Clinical Subject Matter Expert - Managed Care (Compact & CA Licensed)

Company Description

Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted entities.

We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity.

Position Responsibilities

Personal Delivery:
• Provide direction for health plan market/ product operational entry, oversight, management and performance improvement
• Leverage advanced industry expertise and expert knowledge, grounded in research and industry best practice, to provide high value consulting and advisory services
• Deliver innovative, integrated solutions in support of client goals and engagements
• Deliver concise, clear interpersonal communication to both internal and external audiences
• Influence others to best course of action through advanced understanding of changing business landscapes
• Develop or update policies, procedures, processes and workflows as required to support business needs and requirements

Delivery Oversight:
• Act in interim leadership capacity to provide supervision and oversight for teams and activities in an indirect supervisory model by:
• Identify opportunities to improve workflow, generate accurate, high-quality productivity, support organizational compliance with requirements and deliver reductions in associated costs with improvement in organizational quality performance in collaboration with Client leaders
• Lead engagements, acting as the Engagement Manager, to ensure completion of all contracted services by:
• Evaluate and ensure completion of integrated project plans
• Manage coordination and execution of plan activities to achieve key milestones and meet delivery expectations
• Evaluate, write and deliver project reports
• Present findings, recommendations and plans to Client executives
• Facilitate complicated problem-solving discussions to drive to timely, effective decision making
• Advise on risk and benefit discussions to persuade key decision makers and influencers on next steps
• Coach and motivate staff to reach established engagement goals, deliverables and KPIs
• Adapt processes, approach, plan and/ or activities in real time when project targets, goals or timelines are at risk to ensure critical path activities are achieved
• Responsible for the engagement quality, maintaining appropriate resources, competency training and education of staff
• Responsible for approving and managing day to day engagement resourcing/ time and attendance for assigned projects/ teams, which can include, but not limited to:
• Approving paid time off requests, ensuring they don’t put the project at risk
• Pre-approving overtime usage
• Ensuring team members submit their time by the published deadlines
• Validating time entered is accurate (e.g. hours, Pay Type/Time Code, Client/Project/Role) ensuring no risks to billing for that time
• Approving any billable expenses ensuring such expenses were pre-approved by Client, comply with Client’s specific expense policy, if applicable, and are reasonable
• Oversee compliance with internal client related audits, support Client preparation for external audits and surveys
• Facilitate streamlined exchange of information with all levels of Clearlink and client organization(s)
• Articulate performance across multiple projects with qualitative and quantitative results/ outcomes
• Provide delivery assurance support for engagements with assigned clients
Business Development:
• As an solution/ service Subject Matter Expert (SME), identify market trends and develop strategies, goals and plans in response to changing business conditions
• Leverage personal, professional network to identify and deliver new key relationships and sales opportunities
• Provide market facing thought-leadership through presentations, professional affiliations, and social media
• Create and develop Clearlink specific tools, accelerators, intellectual property, and assets to be used in the design, delivery, innovation and building of Company’s expertise and long-term client relationships
• Support account management relationships with key client decision makers
• Identify opportunities to streamline and/ or automate workflows for accurate, high-quality production and improved results in cost savings, or outcomes measurement.

Talent Acquisition:
• Provide insight into necessary skill sets/ expertise including the screening, identification and management of designated industry resources to support and deliver contracted work

Position Qualifications:

Competencies
• Proficiency managing complex work in challenging environments through the alignment of resources and prioritization of efforts to ensure on time, in scope project and/ or strategic delivery
• Managed care industry expertise in trends, innovation, operations, financing, costs, requirements, performance and outcomes
• New product/ market design and implementation in the Commercial, Medicare, Medicare Advantage, Medicaid or associated lines of business
• New population identification, program design and implementation to support needs/ requirements of increasingly complex memberships while ensuring stable operations and target outcomes
• Strong understanding of legal and regulatory frameworks, healthcare administration models, and internal audit procedures
• Ability to understand, interpret and educate on complex concepts such as the Knox-Keene Act and HIPAA, regulations such as State’s Department of Insurance, Federal and State Health and Human Services and requirements/ standards from CMS, NCQA, and URAC, to ensure compliance with complex regulatory structures
• Strategic thinker with ability to produce and manage system-wide change through influence and persuasion
• Knowledge of project management principles, methods, and techniques
• Ability to organize, prioritize, and manage multiple complex projects simultaneously
• Excellent communication skills both written and oral
• High proficiency with core office software (Excel, Word, and PowerPoint) - Visio skills preferred

Experience
• Current unencumbered Compact and California RN license
• Bachelor’s Degree in Nursing, Healthcare Administration or related field, Master’s degree preferred
• 5+ years progressive leadership experience in health plan operations, delivering results and managing teams and projects in a health plan setting and/or consulting environment; driving complex, multi-faceted, multi-site, application/operational change/improvement programs and activities
• 3+ years of management experience in a government payor environment at a Director or equivalent level with experience in multiple lines of business (Medicare, Medicaid, Healthcare Exchange, etc)

Physical Requirements
• Must be able to sit in a chair for extended periods of time
• Must be able to speak so that you are able to accurately express ideas by means of the spoken word
• Must be able to hear, understand, and/or distinguish speech and/or other sounds in person, via telephone/cellular phone, and/or electronic devices
• Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse
• Must be able to clearly use sight so that you are able to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types
• Must be able to fluently communicate both verbally and in writing using the English language
• Must be able to engage in continuous social interaction, successfully manage stressful high conflict situations, and balance multiple duties, expectations and responsibilities simultaneously

Time Zone: Eastern, Central, Mountain or Pacific

Other Information
• Expected Hours of Work: Monday – Friday 8 am – 5 pm; with ability to adjust to Client schedules as needed
• Travel: May be required, as needed by Client
• Direct Reports: None
• Salary Range: $140,000- $185,000

EEO Statement

It is Clearlink Partners’ policy to provide equal employment opportunity to all employees and applicants without regard to race, sex, sexual orientation, color, creed, religion, national origin, age, disability, marital status, parental status, family medical history or genetic information, political affiliation, military service or any other non-merit-based factor in accordance with all applicable laws, directives and regulations of Federal, state and city entities. This salary range reflects the minimum and maximum target wage for new hires of this position across all US locations. Individual pay will be influenced by Experience, Education, Specialized Soft Skills, and/or Geographic location.

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