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The Clinical Business Lead works on problems of diverse scope and complexity ranging from moderate to substantial.

As Regional Clinical Advisor, you serve as a key member of the regional clinical team responsible for supporting data-driven clinical strategy, performance monitoring, and continuous quality improvement within the Medicare Advantage program to support improving the health of members. The Clinical Advisor requires close collaboration with regional leadership and cross-functional teams to ensure alignment with initiatives to drive improved member health outcomes.  The Clinical Advisor plays a key role in advancing regional clinical strategy by working directly with the Regional Vice President of Health Services (RVP) and Health Services Director (HSD). This position focuses on enabling connections with providers, supporting innovation initiatives, implementing clinical programs, managing vendor relationships, and contributing to performance management and governance/delegation oversight.

Primary Responsibilities:

Data Analytics to Support Clinical Strategy, Performance Reporting, and Monitoring:

• Analyze chronic condition performance so regional clinical leadership can bring insights to provider groups to drive awareness, education and action plans. 
• Evaluate the effectiveness of clinical program initiatives through analysis of the downstream impact of such initiatives on facility and provider performance in value-based programs.
• Identify opportunities for new clinical program initiatives by assessing cost and utilization drivers, inclusive of a chronic condition focus.
• Support facility case review discussions with pre-meeting analysis of submitted case reviews as needed.
• Prepare data and evaluate performance to support RVP and HSD in governance and delegation oversight committee and interact with the corporate delegation compliance and auditing teams.

Cross-Functional Collaboration with Key Stakeholders:

• Collaborate with cross-functional teams and internal stakeholders to ensure alignment of clinical strategies with regional executive leadership.
• Serve as a clinical liaison to the provider engagement team to ensure consistent execution of initiatives.
• Serve as a clinical liaison for provider partners regarding utilization management operations questions, interfacing with central UM team.
• Collaborate with the delegation team to identify and resolve performance issues or access concerns.

Compliance and Quality Improvement:

• Support regional leadership in maintaining compliance with clinical best practices and regulatory standards.
• Participate in continuous quality improvement initiatives, including root cause analysis, best practices to close care gaps.

Vendor/Pilot Program Evaluation and Monitoring: 

• Coordinate the implementation of clinical vendor programs across the region, ensuring operational readiness, provider education, and ongoing support for seamless integration.
• Assist in the evaluation of clinical program pilots and vendor supported initiatives through analysis and monitoring of key performance indicators.
• Track vendor performance metrics and collaborate with finance team to prepare performance reports to support data-driven decision making and support a ROI.
• Provide insights to inform program scalability and effectiveness.

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s degree in a science or health-related field.
• Minimum of 5 years of experience in the healthcare industry.
• Minimum 3 years of experience in data analytics, clinical operations, care management, quality improvement, or vendor oversight.
• Proficient in analyzing and representing data using tools visualization tools (e.g., Excel, Tableau, Power BI) and interpreting it for various audiences.
• Strong understanding of value-based care, population health, and clinical quality metrics.
• Experience managing or supporting third-party vendor relationships in a healthcare setting.
• Excellent organizational, communication, and problem-solving skills.
• Proven ability to provide high-quality, responsive service to internal and external stakeholders.
• Demonstrated ability to lead through influence and collaborate across teams.
• Thrive in a remote work environment with independent work skills.
• Travel expected 5-15%

Preferred Qualifications

• Advanced Degree (such as MSN, MBA, MHA, MPH).
• Experience in managed care, health plan operations, or Medicare Advantage programs (including various SNP pro