Clinical Subject Matter Expert (SME)

HealthEdge

1d • $113,000 - $120,000 • Remote

About The Position

As a Clinical SME, you will serve as a trusted clinical advisor to implementing and existing clients, guiding them through complex workflow design, regulatory requirements, and platform optimization. You will work across functional teams — including Product, QA, Business Intelligence, and Implementation — to ensure GuidingCare is configured and utilized to its fullest potential. This is a journey-level, fully qualified individual contributor role offering significant autonomy and impact.

Requirements

• Degree in Nursing, Medical Social Work, Healthcare Informatics, or a related field
• Health plan experience, specifically in Case Management, Utilization Management, Appeals & Grievance, and Population Health
• Minimum 5 years of experience in the healthcare management industry or within a healthcare-focused software company
• At least 2 years in an external, client-facing role
• Deep knowledge of clinical practices and federal/state healthcare regulations
• Demonstrated ability to work autonomously with minimal direction, managing multiple priorities effectively
• Strong communication skills with the ability to adapt messaging for clinical, technical, and executive audiences

Nice To Haves

• Experience with care management platform implementations
• Familiarity with NCQA, URAC, CMS, or HEDIS standards and compliance requirements
• Experience contributing to product development or QA testing cycles within a healthcare software environment

Responsibilities

• Lead discovery sessions to elicit, document, and translate detailed clinical and workflow requirements into actionable GuidingCare configurations, ensuring alignment with applicable regulatory and accreditation standards
• Design and deliver clinical workflows utilizing GuidingCare standard features in accordance with industry best practices and the client's defined model of care
• Provide independent clinical leadership throughout client implementations, encompassing change request management, issue resolution, and proactive risk mitigation
• Develop and deliver advanced clinical training, adapting content, depth, and communication style to meet the needs of diverse stakeholder audiences
• Present new system functionality and facilitate product release demonstrations for client audiences
• Conduct Optimization Assessments and lead the development of follow-up recommendations to support continuous client improvement
• Provide ongoing production support, recommending clinically sound solutions consistent with GuidingCare best practices
• Contribute clinical expertise across cross-functional teams, including product development, supporting solution design, strategic positioning, feature validation, and the advancement of platform functionality in response to evolving clinical and regulatory needs
• Maintain current knowledge of Healthcare Information Technology trends, federal and state regulatory changes, and healthcare insurance operations across multiple lines of business, applying that expertise to inform client workflow design and implementation guidance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level