Job Description
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 . Apply tot his job