Clinical Consultant at Hearst

DescriptionThe 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 LeadershipLead 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 & OptimizationProvide 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 clients goals and use cases.Growth & Product InfluenceSupport 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:Bachelors 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 MHKs 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 members 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 relationshipswith MHK clients and one anotherthrough responsive transparent communication while honoring commitments and tying that trust to outcomes.2025 Benefits Snapshot:Medical vision and dental plans for full time employees401(k) offered with a generous matchBenefits begin on first day of the month following employment Exercise/Health Club reimbursement opportunityMonthly dependent care reimbursementopportunityShort Term and Long Term disabilityBasic Term Life and AD&D InsurancePaid Time Off18 days Paid Time Off15 Company Paid HolidaysEQUAL OPPORTUNITY EMPLOYER - VETERANS/DISABLED. Always be aware of Recruitment FraudRequired Experience:Contract Key Skills CSS,Cloud Computing,Health Education,Actuary,Building Electrician Employment Type : Full-Time Experience: years Vacancy: 1