Note: The job is a remote job and is open to candidates in USA. Confidential Jobs is seeking a Clinical Consulting SME who will serve as a trusted advisor throughout all phases of client engagement. This role involves leading healthcare clients through product workflow transformation and ensuring alignment with industry best practices and compliance standards.
Responsibilities
• Partner with clients and internal teams to assess current workflows, identify optimization opportunities, and support implementation through post–go-live phases
• Provide clinical and operational guidance on system configuration, integrations, and regulatory reporting
• Collaborate with Business Operations, Project Management, Compliance, and Development teams to deliver an exceptional client experience
• Advise clients on issue resolution, best practices, and workflow improvements
• Support business development activities, including discovery sessions, demonstrations, and RFP input
• Contribute to product and solution enhancements by sharing clinical insights and identifying process improvement opportunities
Skills
• 5+ years in clinical consulting, healthcare technology, or solution implementation
• Strong understanding of healthcare regulations, payer/provider workflows, and quality programs (HEDIS, STAR)
• Strong ability to engage with clients on UM, CM and Appeals issues and workflows is required
• Excellent communication, facilitation, and problem-solving skills
• Willingness to travel as required up to 25% as needed to clients, conferences
• Licensed clinician (RN, RPh, LPN or equivalent) preferred, with experience in health plan, PBM, or care/utilization management operations
• Experience with AI tools is a huge plus
Company Overview
• Confidential Jobs It was founded in 2023, and is headquartered in Bangalore, Karnataka, IN, with a workforce of 51-200 employees. Its website is .
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