Clinical Account Manager, Consultant - Commercial

Your Role

The Commercial CMO team works across multiple teams within Blue Shield to ensure smooth implementations for the commercial lines of business. The Program Manager Clinical Consultant, will report to the Regional Medical Director. In this role you will be responsible for working on externally facing health system accounts, business accounts, and special projects as part of the Commercial CMO team.

You will oversee various commercial lines of business with a focus on clinical program management responsibilities, working closely with medical care management functional area teams, quality, account management, medical directors, sales, vendors and clients.

Key components include leveraging extensive clinical knowledge to liaison between internal and external stakeholders to support successful performance. You will also support high profile client interactions using clinical knowledge and advanced data skills to advise and resolve Health System and client escalations. Additionally, you are responsible for managing projects and business process improvement activities to ensure ongoing alignment with Blue Shield of CA's strategy and company objectives, as well as interdependencies of other business units.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Valid CA license in a clinical discipline such as RN, NP, PA

• Typically, requires a college degree or equivalent experience and minimum 7 years of prior relevant experience

• Requires previous health plan experience with understanding of Accountable Care Organizations (ACO), global versus shared risk financial arrangements, quality metrics and member experience. Experience in case utilization and utilization management and managed care delegated models is a plus.
• In-depth understanding of data analytics with mastery of excel and an ability to use multiple data platforms for internal and external communication.
• Strong PowerPoint application skills to create executive summaries and presentation decks.
• Exceptional communication and presentation skills
• Ability to synthesize clinical data into a concise story
• Ability to think outside of the box and quickly problem solve
• Excellent analytical skills

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.