CareFirst BlueCross BlueShield

Clinical Advisor - (Registered Nurse) - (Remote)

Posted on

May 4, 2025

Job Type

Full-Time

Role Type

Clinical Operations

License

RN

State License

Compact / Multi-State

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Company Description

Job Description

Must live in MD, DC, VA PURPOSE: The Clinical Advisor's role is multifaceted from data analytics, client facing presentations, and solutions optimization. The Clinical Advisor will extract clinical and relevant data to educate clients, brokers, consultants, and internal stakeholders, showcasing the value of the organization's approach to managing care delivery. The Clinical Advisor will synthesize data and make individualized recommendations related to population health with a goal of improving outcomes and driving down cost in populations. The Clinical Advisor serves as key subject matter expert and strategic partner for the Sales team and will regularly attend onsite and virtual client meetings to review health outcomes and cost information.

Requirements

QUALIFICATIONS: Education Level: Bachelor's Degree in Nursing, Pharmacy, Psychology, Behavioral Health, Social Work or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience Licenses/Certifications: RN - Registered Nurse - State Licensure And/or Compact State Licensure. Experience: 4 years experience working in a clinical setting. 2 years demonstrated experience with healthcare data analysis. Preferred Qualifications: Graduate degree such as MSN, MBA, MPH. Knowledge of health plan sales or account management. Experience working in a health plan environment in a business role. Knowledge, Skills and Abilities (KSAs): Ability to present onsite and virtually to both small and large audiences. An in-depth knowledge of current and emerging trends in care management. Ability to work closely with and influence people at all levels, including C-suite executives, vice presidents, directors, managers, and associates. Critical thinking and judgment with the ability to connect the dots, put the story together and then deliver to the client in a professional manner. Demonstrated ability to analyze and interpret data. Ability to lead/coordinate projects and function as a resource to other CareFirst departments. Ability to communicate effectively, both verbally and in writing. Ability to present and communicate in group settings in a professional manner. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for extended periods of time. Must be able to meet established deadlines and manage multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

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Responsibilities

Analyzes population health data as well as clinical and financial trends, for existing and prospect customer accounts. Develops business case studies and next generation reports to demonstrate the value of care management and wellness approaches. Makes strategic recommendations for key accounts and their consultants/brokers to retain and grow business. Delivers presentations and demonstrates to external clients, customers and prospects the value proposition and return on investment of assigned solutions. Consults with key stakeholders regarding cost containment and quality improvement for their employee populations. Identifies gaps in care and make referrals to appropriate programs. As a clinical subject matter expert, reviews and analyzes member data to show value of care management programs. Collaborates with internal teams including wellness, pharmacy, and care management. Creates and executes upon a sales strategy for the assigned solutions to help customers meet their clinical goals. Present and demonstrate to external clients, customers and prospects the value proposition and return on investment of assigned solutions in a consultative approach. Consult about how to best control cost and improve quality for their employee populations. Using clinical knowledge, review and analyze member data to show the value of the organizations care management efforts; identify gaps in care and make referrals to appropriate programs.

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