Senior Consultant, Clinical Consulting
Senior Consultant, Clinical Consulting-(NAT0000009F)Description
Are you passionate about delivering trusted advice that improves lives?
Are you a Clinical Consultant and expertwith your advanced knowledge of the strategic and more technical complex health plan issues that is passionate about realizing significant opportunities with population health management programs such as onsite clinics, digital therapeutics, wellness, clinical audits, direct contracting, management of high cost claimants?Our opportunity may be for you!
Key Responsibilities:
Deliver consulting and client projects including clinical audits and onsite clinics and collaborate with client team to help clients maximize the value of their healthcare spending
Act as a technical resource, expert and advisor on complex plan issues and the management of population health management programs such as onsite clinics, digital therapeutics, wellness, clinical audits and direct contracting
Conduct extensive data analytics using claims data warehouse tools
Design and implement onsite health optimization projects (e.g., onsite clinics) including analyzing the effectiveness and efficiency
Through deep technical data analysis, recognize trends and identify opportunities for clients and CRMs
Conduct and report on clinical audits of disease management programs
Design and develop internal tools and marketing collateral and sales support for vendor procurement, implementation and auditing of clinical services
Consult directly to clients on plan design, care management, vendor selection, procurement, optimization, financial and regulatory aspects and identify and recommend innovative health and wellness strategies and initiatives such as digital therapeutics
Critically evaluate execution of vendor services in accordance with contracts and plan documents
Draft statements of work, project plans and budgets involving multiple workflow streams and client teams
Support marketing and business development efforts involving health consulting nationwide
Conducting senior level peer review of practice-related work products and maintaining and/or enhancing standards for technical quality and professional competence relating to health consulting.
Qualifications
Minimum of ten years of experience within a health benefits or health benefits consulting and/or related professional consulting firm or in a corporate environment involving significant exposure to health plan strategies, concepts/approaches, design and implementation.
Undergraduate degree, advanced degree preferred.RN, BSN, PA designation or other clinical background highly preferred.
Hands on data analysis and report generation experience.
Deep and broad-based expertise in health care, onsite clinic management and care regimes.
Experience with pre-certifications, medical records review and coordination of claims appeals resolution.
Previous expertise with launching and/or managing onsite clinics or telemedicine programs helpful.
Knowledge of HIPAA, COBRA, Health Reform, Medicare and Mental Health Parity laws.
Knowledge of patient cost-sharing, deductibles, copays, coinsurance and out of pocket limits.
Demonstrated experience and success in managing client relationships either on a primary or secondary basis and leading / participating in business development activities and other initiatives designed to grow revenue and profitability.
Large and/or complex/interdisciplinary-oriented project management experience.
Demonstrated experience and success in managing client relationships either on a primary or secondary basis and leading / participating in business development activities and other initiatives designed to grow revenue and profitability.
Strong presentation skills, negotiation skills, effective written skills and strong attention to detail.
Expertise with Microsoft Office Suite products including Word, Excel and PowerPoint. Knowledge of SQL preferred.
Strong intellectual curiosity and desire to keep abreast and share with others the latest developments in care management and health and wellness plan strategies.
Diversity, Equity & Inclusion at Segal
We recognize that individuals bring a broad range of experience and abilities that go beyond the technical requirements of a job. If your experience and qualifications are close to what you see described here, we encourage you to apply.Diversity of employment, skills and life experience, combined with passion, are key to innovation and excellence. We
encourage individuals, including but not limited to women, minorities, the disabled and protected veterans and those
from all other
backgrounds to apply
to our positions. Please let us know if you require accommodation during the interview process andthank you for considering Segal.
About Segal and its Total Rewards Program
Segal is aprivately owned
, leading North American employee benefit, human resources and investment management consulting firm with
over 85 years of history
providing trusted advice that improves lives. Clients include public and private corporations, multiemployer trust funds, public sector entities, higher education institutions, institutional advisors, among many others.
Segals total rewards are part of what makes Segal a special place to work. The current salary range for this position is $124,500 to $165,000 plus opportunity for a discretionary performance bonus with a target of 18% based on company profitability and employee performance.In addition, Segal offers a comprehensive suite of benefits to include a non-contributory defined benefit pension plan, matching and discretionary contributions to a 401(k) profit sharing plan, medical and prescription benefits including contributions to a health savings account for eligible employees, dental benefits, life insurance, disability insurance, an Employee Assistance Program, wellness benefit reimbursements and rewards, and professional credential and tuition reimbursement.
Segal also provides comprehensive paid time off including holidays, vacation days, sick leave, paid family leave and sabbaticals.
Please Apply
Segal is the right size, the right organization andthe right move for you! Please apply now.
#LI-Remote
Primary Location:US-IL-ChicagoOther Locations:US-AZ-Tempe, US-MA-Boston, US-CA-Glendale, US-CA-San Francisco, US-MI-Lansing, US-GA-Atlanta, US-MN-Bloomington, US-NY-New YorkWork Locations:Chicago101 North Wacker Drive, Suite 500Chicago60606Job:Consulting - Non-Actuarial BenefitsOrganization:National OfficeSchedule:RegularRegular EmployeeEmployee Status:Experienced LevelJob Type:Full-timeTravel:Yes, 25 % of the TimeJob Posting:Jan 30, 2025, 2:51:49 PM