Sr Clinical Consultant

Who We Are

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.

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health (https://www.point32health.org/) .

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.

Job Description

Key Responsibilities/Duties – what you will be doing (top five):

• Employer Performance and Clinical Content

• Utilizing cost, quality and utilization reports, and discussion with team, the Sr. Relationship Clinical Consultant will work in conjunction with other departments as needed

• Analyzes data and metrics from a variety of departments and sources to effectively communicate with groups clinically related material related to their plan’s performance

• Works collaboratively with the team to develop the performance review presentations

• On an ongoing basis reviews data related to performance metrics and alerts on any issues or concerns related to clinical performance

• Identifies and coordinates clinical strategies to assist with addressing any plan performance concerns

• Serves as a resource for issues related to clinical content on the portal

• In collaboration with team assists with the development of recommendations and works with the team to implement

• Provides daily support to resolution of escalated issues or questions

• Collaborates with internal departments to research and provide a response

• Implements training on company resources and alternative paths for problem resolution

• Redirects to other Point32Health key points of contact

• Account Clinical Performance Guarantees

• Works in collaboration with other departments to develop clinical performance guarantees

• Ensures processes are in place to track clinical performance guarantees related to applicable accounts and intervenes as needed if guarantees are not being met

• Assists with Provider Relationships

• Jointly works with the Medical Director to establish provider relationships as needed

• Assists with the development and implementation of provider collaborations and oversees coordination requiring other departments within the organization

• Participates in and assists with provider meetings

• Works in collaboration with Provider Performance, Provider Contracting and Quality teams as necessary

• Other

• May be asked to participate in functions and activities other than the above in supports of the department, division, and organization as Pont32Health continues as the organization of Point32Health continues to develop

• Other projects and duties as assigned.

Qualifications – what you need to perform the job

Certification and Licensure

• Current Registered Nurse state license

Education

• Required (minimum): Associate's degree in nursing or BSN

• Preferred: Master’s degree; MPH very desirable

Experience

• Required (minimum): 5 – 7 years of clinical nursing experience

• Preferred: Patient education experience desirable

Skill Requirements

• Proficiency in a second language is also highly desirable

• Worksite Wellness consultation desirable

• Excellent verbal and written communication, active listening skills, and high-level presentation skills

• Ability to analyze and comprehend complex data

• Address multiple complex issues throughout the workday in a flexible professional manner.

• Requires initiative, sound judgment, and the 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.

• Requires excellent web and business writing skills as well as project or program management experience.

• Strong computer skills required 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.

• Must have commitment to excellence in customer service.

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

• 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.

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.

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.

Point32Health offers their Colleagues 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 https://www.point32health.org/careers/benefits/

We welcome all

All applicants are welcome 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.

Scam Alert : Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact [email protected]

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 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.