<p>The 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.</p> <p>Key Responsibilities:</p> <p>Advisory & Implementation Leadership</p> <ul> <li>Lead executive and operational discussions to assess current Care Management, UM, and CAG workflows and define future-state best practices. </li><li>Direct discovery sessions, requirements documentation, and identification of automation and efficiency opportunities. </li><li>Serve as the clinical authority throughout implementation, guiding data mapping, integrations, regulatory reporting, and workflow design. </li><li>Proactively identify risks, advise on issue resolution, and ensure alignment with compliance, quality, and operational objectives. </li><li>Ensure transparency in communication and deliverables to reinforce trust and credibility. </li></ul> <p>Client Enablement & Optimization</p> <ul> <li>Provide expert guidance on system functionality, workflow validation, testing, and defect triage. </li><li>Conduct health checks, benchmarking, and performance reviews to ensure clients maximize automation, accuracy, and outcomes. </li><li>Recommend targeted workflow improvements, configuration changes, and integration enhancements to strengthen efficiency and user experience. </li><li>Educate clients on regulatory intent and operational impacts, simplifying complex requirements into actionable steps. </li><li>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 client's goals and use cases. </li></ul> <p>Growth & Product Influence</p> <ul> <li>Support Sales through advanced clinical discovery, process analysis, and CareProminence demonstrations. </li><li>Contribute clinical expertise to RFP responses and strategic solution recommendations. </li><li>Partner with Product and Development to surface enhancement opportunities and shape roadmap priorities based on real-world clinical and operational needs. </li></ul> <p>Skill Requirements:</p> <ul> <li>5+ years in clinical consulting, healthcare technology, or solution implementation preferred. </li><li>Strong knowledge of regulatory requirements, payer workflows, and clinical quality programs (HEDIS, Stars preferred). </li><li>Proven ability to influence senior stakeholders, lead complex engagements, and drive measurable operational improvements. </li><li>Exceptional communication, facilitation, and problem-solving skills. </li></ul> <p>Education/Certification Requirements:</p> <ul> <li>Bachelor's Degree in Nursing or Healthcare </li><li>Licensed clinician preferred (RN, RPh, or equivalent) with deep experience in Care Management, UM, and CAG. </li></ul> <p>Additional Requirements:</p> <ul> <li>Demonstrated alignment with MHK's values of Integrity, Client Focus, Ownership, Collaboration, and Continuous Improvement. </li><li>Willingness to travel up to 20% </li><li>All prospective candidates must be able to pass a pre-employment background check and drug screening. </li></ul> <p>At MHK we help health plans and pharmacy benefit managers deliver optimal care management across every member's 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 relationships-with MHK clients and one another-through responsive, transparent communication, while honoring commitments, and tying that trust to outcomes.</p> <p>2025 Benefits Snapshot:</p> <ul> <li> <p>Medical, vision, and dental plans for full time employees</p> </li><li> <p>401(k) offered with a generous match</p> </li><li> <p>Benefits begin on first day of the month following employment</p> </li><li> <p>Exercise/Health Club reimbursement opportunity</p> </li><li> <p>Monthly dependent care reimbursement opportunity</p> </li><li> <p>Short Term and Long Term disability</p> </li><li> <p>Basic Term Life and AD&D Insurance</p> </li></ul> <p>Paid Time Off</p> <ul> <li> <p>18 days Paid Time Off</p> </li><li> <p>15 Company Paid Holidays</p> </li></ul> <p>EQUAL OPPORTUNITY EMPLOYER - VETERANS/DISABLED. Always be aware of Recruitment Fraud</p>