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, opportunities, 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 monitors results and metrics to ensure deliverables are met and compliance with department and regulatory standards.
Effectively communicates with leadership, team, and business partners to gain knowledge, problem-solve, enhance program delivery, and present findings to internal and external parties.
Provides oral overviews of clinical programs and services as part of broker or prospective account presentations; and advises on opportunities to improve health plan performance.
#LI-Remote
The expected hiring range for a Clinical Program Consultant is $83,300 - $112,700 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 10%. The current full salary range for this role is $78,000 - $128,000.
The expected hiring range for a Clinical Program Consultant Sr is $100,300 - $135,700 depending on skills, experience, education, and training; relevant licensure / certifications; and performance history. The bonus target for this position is 15%. The current full salary range for this role is $94,000 - $154,000.
About Cambia
Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.
Why Join the Cambia Team?
At Cambia, you can:
Work alongside diverse teams building cutting-edge solutions to transform health care.
Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
Grow your career with a company committed to helping you succeed.
Give back to your community by participating in Cambia-supported outreach programs.
Connect with colleagues who share similar interests and backgrounds through our employee resource groups.
We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.
In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:
Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
Annual employer contribution to a health savings account.
Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
Award-winning wellness programs that reward you for participation.
Employee Assistance Fund for those in need.
Commute and parking benefits.
Learn more about our benefits.
We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.
We are an Equal Opportunity and Affirmative Action 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 background check is required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy.
