This job was posted by https://idahoworks.gov : For more information, please see: https://idahoworks.gov/jobs/2305083 Clinical Program Consultant or Senior DOE

Work from home within Oregon, Washington, Idaho or Utah

Travel locally or out of state may be required

Build a career with purpose. Join our

Cause

to create a person-focused and economically sustainable health care system.

Who We Are Looking For:

Every day, Cambia\'s dedicated team of Clinical Program Consultants are living our mission to make health care easier and lives better. As a member of the Clinical Program Consultant team, our Clinical Program Consultants utilize clinical expertise from diverse experiences, this role prepares, informs, and consults on health plan performance reporting and clinical programs to support customer recommendations that promote member health and wellbeing while mitigating cost drivers.

Collaboration with internal and external partners occurs to address customer needs, analyze reports, evaluate program deliverables, and offer recommendations. Health plan utilization and cost analysis is conducted to identify trends and causes of healthcare expenditures. This research is performed to educate on the value and cost savings of utilization and care management programs among others. Additionally, this role supports customer program up-sales, responds to member-specific clinical inquiries regarding health care status and treatment plans - all in service of making our members\' health journeys easier.

Are you passionate about healthcare and want to join a team that\'s dedicated to improving health outcomes and wellbeing? What if you could use your clinical skills and experience to help others thrive? Then this role may be the perfect fit.

What You Bring to Cambia:

Qualifications:

• Clinical Program Consultant would have a clinical license, Bachelor\'s degree in Nursing
• 5 years of clinical nursing with a combination of experiences in one area of case management, utilization management, behavioral case management or employee benefit consulting with an equivalent combination of education and experience
• Clinical Program Consultant Senior would have a clinical license, Bachelor\'s degree in Nursing
• 8 years of clinical nursing with a combination of experiences in one or more areas of case management, utilization management, behavioral case management or employee benefit consulting with an equivalent combination of education and experience. Preference for leadership experience.
• Clinical license, Registered Nurse.
• Experience in a variety of health care fields is preferred

Skills and Attributes:

• Ability to evaluate program effectiveness, identify issues and opportunities, and work to continuously improve programs offered, with strong analytical and problem-solving skills, including data abstraction, quantitative, qualitative, and analytical skills.
• Strong communication and presentation skills with internal and external audiences, including the ability to resolve issues with diplomacy and persuasiveness, build consensus among diverse stakeholders, and interpret and present complex data for problem-solving and consulting with others.
• Knowledge of health insurance industry trends, technology, and state regulatory requirements, including HEDIS.
• Experience in areas of medical case management for complex cases and utilization management practices, with the ability to translate data into actionable plans.
• Ability to organize, plan, prioritize, and develop multiple projects within time constraints, with a customer mindset and proven ability to build positive relationships, gain trust and respect, and influence others.
• Strong knowledge of data analysis, with the ability to identify trends, o portunities, and issues, and develop data-driven solutions.
• Ability to work collaboratively with diverse stakeholders, build consensus, and drive continuous improvement, with a focus on delivering high-quality programs and services.

What You Will Do at Cambia:

Analyzes health plan data to understand financial and utilization trends; and presents clinical data findings in an easy-to-understand manner to inform customers and advise on opportunities to improve health plan performance.

Stays up-to-date on Regence clinical programs, including those for fully insured members and buy-up options for self-funded groups, and educates leadership, colleagues, and business associates on their value proposition.

Conducts research and root cause analysis on member, provider, vendor, or process issues, and effectively communicates clinical and process findings to others using self-service report systems.

Develops and implements monitoring and control procedures with internal operational leaders to improve work initiatives, track operational achievements, and identify opportunities for improvement.

Collaborates with internal and external business partners to collect, analyze, and maintain relevant data, and