Cambia Health Solutions

  • Clinical Program Consultant

    Job Locations US-ID-Lewiston | US-OR-Portland | US-WA-Burlington | US-WA-Seattle | US-UT-Salt Lake City
    Requisition ID
    Category (Portal Searching)
    Health Care Services
  • Overview

    Clinical Account Manager

    Lewiston, ID; Portland, OR; Burlington, WA; Seattle, WA or Salt Lake City, UT



    At Cambia, our values are fundamental to achieving our Cause of transforming the health care industry. They guide our actions and bring diverse perspectives together to improve the health care journey better for those we serve. All eight values are equally important and linked to the others: Empathy, Hope, Courage, Trust, Commitment, Innovation, and Accountability. These values are not just words on paper - we live them every day.

    Responsibilities & Requirements

    As the Clinical Account Manager, you will utilize clinical knowledge and care management experience to develop and consult with others regarding health plan clinical programs. You will collaborate with Clinical Services staff, departments across the organization, and external partners and provide education, training, or analysis related to care management and/or utilization management programs to enhance program quality, value and cost effectiveness.


    The Senior Clinical Program Consultant regularly provides consultative clinical support to external audiences such as provider partners, brokers, customer accounts or prospective accounts. Develops and presents clinical content and uses data to recommend clinical programs and services that align with customer strategy and drive adoption and growth of product offerings.


    Responsibilities and Outcomes:


    • Effectively collaborates with internal program contacts and/or external resources to test and develop programs and resolve implementation, compliance, and program design challenges.
    • Conducts research and root cause analysis on member, provider, vendor or process issues and effectively communicates clinical and process findings to others.
    • In conjunction with internal operational leaders develops monitoring and control procedures.
    • Educates and trains the leadership, staff, and business associates regarding clinical program elements and implementation.
    • Collaborates with internal and external business partners on the collection, analysis, and maintenance of relevant data.
    • Provides leadership and operational oversight for all or assigned parts of specific clinical programs. Drives continuous improvement.
    • Monitors results and metrics to ensure deliverables are met and compliance with department and regulatory standards.
    • Utilizes clinical expertise and judgement to ensure compliance with program design, contractual requirements, accreditation standards and accepted standards of care.


    Minimum Requirements:


    • Clinical Program Consultant would have a clinical license, Bachelor’s degree in Healthcare, Business or related field (MPH, MHA or MBA preferred) and 5 years of case management, utilization management, or behavioral case management or equivalent combination of education and experience.  
    • Ability to evaluate program effectiveness, identify issues and opportunities, and work to continuously improve programs offered.
    • Strong communication and presentation skills, including the ability to resolve issues with diplomacy and persuasiveness, and build consensus among groups of diverse stakeholders.
    • Knowledge of health insurance industry trends and technology.
    • Knowledge and experience with data analysis and translation of data into actionable plans
    • Experience in areas of clinical case management and utilization management practices.
    • Knowledge of CMS, state regulatory requirements, and HEDIS
    • Ability to organize, plan, prioritize and develop multiple projects within time constraints.
    • Clinical license (e.g. Registered Nurse, MSW, Pharmacist).

    About Us

    Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. We are an equal opportunity employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check is required.


    Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members more than 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.

    If you’re seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers’ engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.


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