Overview  

This position is responsible for service innovation and product design, focused on advancing behavioral’ s current and future clinical and health advocacy programs using evidenced based best clinical practices, opportunity analytics.  Using a value-based design approach, and other design methods (proof of concept), the Clinical Program Advisor is responsible for independently executing “test and learn” pilots along with current program enhancements.  Critical focus on advancing our programs and care approaches, aligning with the provider/delivery system in support of delivering better quality outcomes, a better patient experience while holding down cost – the Triple Aim.

The team has responsibility for collaborating and aligning with clinical teams across the enterprise, solutions, operations, analytics, network, and IT partners. This role will have a strong focus on supporting development of business and technical requirements and will requiring learning and owning components of applications.

Key Responsibilities (not limited to):

Clinical Program design focused on health improvement goals, driving healthcare costs down and meeting organizational targets.  Focus on ongoing quality improvement, health disparities/literacy, operational efficiency, process and tools, improved customer/healthcare professional experience and engagement.

Responsible for or key team member to:

• Lead launch of pilots/proof of concepts focused on improvement of health outcomes and service design enhancements including increasing the likelihood of desired outcomes [compared to a baseline] and reducing health disparities among specified populations

• Research and define advanced clinical and administrative techniques associated with integrated health trends, case management and utilization management to generate new innovative solutions to advance health outcomes and affordability.

• Evaluation of existing clinical programs with recommended design enhancements and quality improvements, consulting with and providing recommendations to the Product, Clinical Operations, Reimbursement and Collaborative Care team and other key stakeholders. 

• Actively participate in clinical design advancement with a focus on trends including health disparities and literacy. 

• Manage or key support for assigned current clinical programs and advance clinical development to assure clinical/health advocacy program integrity and results, supporting vendor integration through clinical program education, and process and workflow development. (ex: Gaps in Care, Health Advocacy Programs).

• Exudes self-motivated ownership of clinical metric-driven results, continually acting with a sense of urgency to ensure that results are attained, if not exceeded and to champion perpetual change within Behavioral to ensure that we anticipate market trends and offer industry-leading products and services.

• Collaborating with Informatics/Analytics and other key metrics partners to understand results - advancing the performance of our programs and services

  • Service utilization patterns

  • Clinical outcomes

  • High dollar claim trend patterns.

  • Quality outcomes

  • Financial results

Operational Excellence:

• Understands operationally how the organization is structured, workflows and impacts of changes

• Participate in development of cost savings initiatives and facilitate implementation of processes to support value across programs and bring to the market. 

• Partners with the technical writing team, ensuring workflows and SOP’s are aligned with regulations and system capabilities to ensure a positive customer and staff outcome/experience  

• Ability to present ideas and recommendation to leadership teams, often working closing with the behavioral center of excellence, in updating and providing operational support

Technical Skills

• Experience owning or supporting development of Business and Technical Requirements

• Ability and comfort with learning and owning components of applications

• Ability to work collaboratively with key technical and non-technical matrix partners and serve as a technical liaison between business lanes

Strategic Direction and Partnerships:

• Strong driver that supports the team in meeting our membership and financial targets, through the successful execution of clinical, service, and administrative results

• Supports the development of other team members

• Works closely with our network part