Clinical Consultant

1 week ago

Tampa, FL, United States Hearst Full time
Job Description

The Clinical Consultant is a senior clinical and operational expert with deep experience across the integrated spectrum of Care Management services, including Care Management (CM), Utilization Management (UM) and Complaints, Appeals & Grievances (CAG). This role advises health plan and payer executives on implementing best-practice workflows that strengthen compliance, improve health outcomes, and drive meaningful operational efficiency. Serving as a trusted partner across the client lifecycle, the Clinical Consultant brings strategic insight into aligning CM, UM, and CAG functions to support whole-person care, drive quality outcomes, and ensure seamless coordination across clinical touchpoints.

Key Responsibilities:

Advisory & Implementation Leadership
  • Lead executive and operational discussions to assess current Care Management, UM, and CAG workflows and define future-state best practices.
  • Direct discovery sessions, requirements documentation, and identification of automation and efficiency opportunities.
  • Serve as the clinical authority throughout implementation, guiding data mapping, integrations, regulatory reporting, and workflow design.
  • Proactively identify risks, advise on issue resolution, and ensure alignment with compliance, quality, and operational objectives.
  • Ensure transparency in communication and deliverables to reinforce trust and credibility.
Client Enablement & Optimization
  • Provide expert guidance on system functionality, workflow validation, testing, and defect triage.
  • Conduct health checks, benchmarking, and performance reviews to ensure clients maximize automation, accuracy, and outcomes.
  • Recommend targeted workflow improvements, configuration changes, and integration enhancements to strengthen efficiency and user experience.
  • Educate clients on regulatory intent and operational impacts, simplifying complex requirements into actionable steps.
  • Continue to build and grow client trust organically as a clinical advisor by proving an ongoing value through accountability, proactive communication and transparency, while providing tailored solutions aligned to each client's goals and use cases.
Growth & Product Influence
  • Support Sales through advanced clinical discovery, process analysis, and CareProminence demonstrations.
  • Contribute clinical expertise to RFP responses and strategic solution recommendations.
  • Partner with Product and Development to surface enhancement opportunities and shape roadmap priorities based on real-world clinical and operational needs.
Skill Requirements:
  • 5+ years in clinical consulting, healthcare technology, or solution implementation preferred.
  • Strong knowledge of regulatory requirements, payer workflows, and clinical quality programs (HEDIS, Stars preferred).
  • Proven ability to influence senior stakeholders, lead complex engagements, and drive measurable operational improvements.
  • Exceptional communication, facilitation, and problem-solving skills.

    Education/Certification Requirements:
  • Bachelor's Degree in Nursing or Healthcare
  • Licensed clinician preferred (RN, RPh, or equivalent) with deep experience in Care Management, UM, and CAG.
Additional Requirements:
  • Demonstrated alignment with MHK's values of Integrity, Client Focus, Ownership, Collaboration, and Continuous Improvement.
  • Willingness to travel up to 20%
  • All prospective candidates must be able to pass a pre-employment background check and drug screening.
At MHK we help health plans and pharmacy benefit managers deliver optimal care management across every member's health journey. We do this through state-of-the-art technology that provides critical insights from member enrollment and maintenance through every stage of care and compliance. We believe that long-term partnerships are built on trust. Our team members are expected to build trusted advisory relationships-with MHK clients and one another-through responsive, transparent communication, while honoring commitments, and tying that trust to outcomes.

2025 Benefits Snapshot:
  • Medical, vision, and dental plans for full time employees
  • 401(k) offered with a generous match
  • Benefits begin on first day of the month following employment
  • Exercise/Health Club reimbursement opportunity
  • Monthly dependent care reimbursement opportunity
  • Short Term and Long Term disability
  • Basic Term Life and AD&D Insurance
Paid Time Off
  • 18 days Paid Time Off
  • 15 Company Paid Holidays

EQUAL OPPORTUNITY EMPLOYER - VETERANS/DISABLED. Always be aware ofRecruitment Fraud

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