Clinical Account Executive

Job Summary
The Clinical Account Executive (CAE) is a strategic leadership role responsible for overseeing, managing, and retaining large, complex client relationships and driving long-term success for strategic and large market accounts. The CAE applies advanced clinical expertise and extensive healthcare operations knowledge to deliver exceptional client experiences, align business strategies with client objectives, and ensure high-value outcomes.
This role requires independent judgment, strategic communication, and the ability to interpret complex clinical and financial data to influence multimillion-dollar client portfolios. The CAE provides direct clinical analysis of group-specific cost drivers and trends with actionable solutions, serves as an escalation path for client issues, and trains and oversees the Clinical Account Consultant (CAC) role.

Essential Functions

• The essential functions listed represent the major duties of this role, additional duties may be assigned. (5%)
• Client Support and Issue Resolution:
  
  Develop and maintain a thorough understanding of client's objectives for their benefits plan, as it relates to the clinical
  components of the plan.
  
  Maintain knowledge of the client's performance indicators that the clinical team will be responsible for and held accountable to.
  
  Recommend/model changes necessary to achieve objectives within the clinical teams.
  
  Responsible for daily evaluation of account reporting/needs and implement processes or staffing to support specific account
  requirements.
  
  Responsible for problem resolution with escalation to the Sr. Director as appropriate.
  
  Collaborate with clinical staff as an initial resource escalating to Account Management and POD when necessary.
  
  Respond to client inquiries within 24 business hours - acknowledge and build expectations for resolution and deliver on
  commitments.
  
  Understand what clinical programs each client has purchased and how that client wants to utilize the programs to address their
  specific areas of interest and focus.
  
  Leverage problem-solving skills and frameworks to develop solutions to client's business problems.
  
  Assist clients and internal teams in addressing escalated issues related to clinical areas. (40%)
• Management and oversight of Clinical Account Consultants:
  
  Performance Monitoring and Development
  - Conduct regular one-on-one meeting with CACs to review performance metrics, discuss client feedback, and identify areas for professional growth
  - Set measurable goals and provide actionable feedback to ensure CACs meet client satisfaction and organizational standards
  - Establish individualized development plans to support skill-building and career progression with the organization
  
  Training and Onboarding
  - Oversee the onboarding of new Clinical Account Managers, providing training on internal systems, reporting tools, client
  management best practices, and compliance requirements.
  - Develop and Deliver ongoing training programs to ensure CACs stay current with industry trends, new regulations and emerging
  client needs.
  
  Resource and Workload Management
  - Allocate client accounts and responsibilities among CACs to optimize workload distribution and ensure proper coverage
  - Monitor account assignments to balance workloads and ensure high-quality client service
  
  Strategic Insights and Reporting
  - Guide CACs in identifying trends withing small-to mid-market accounts, analyzing data and preparing actionable
  recommendations to improve client outcomes
  - Review and approve key client reports and presentations prepared by the CACs to ensure they meet organizational and client
  expectations.
  
  (25%)
• Data Analysis:
  
  Measure and monitor daily account metrics with appropriate interventions.
  
  Access and navigate various technical platforms and systems that are affiliated with the clinical division and client management:
  iiiPUT, clinical documentation platforms, various applications used by clients, through outside vendors.
  
  Validate, analyze, interpret client data to make effective cost, quality, and shared decision-making recommendations resulting in
  increased client satisfaction and retention.
  
  Conduct clinical analysis and provide input to customized evaluations which includes identification, interpretation, and
  communication of overall account performance against benchmarks and clinical trends, with account specific recommendations to
  improve performance and outcomes.
  
  Work with the internal reporting/analytics team to prepare external client reports. (10%)
• Client Reporting:
  
  Deliver external presentations to clients that demonstrate the value of products, programs, and processes, as well as build an
  ongoing relationship with internal teams at Communitas and WebTPA.
  
  Work with the Director to represent the Clinical division during client calls, meetings (remote or onsite), and presentations. (10%)
• Collaboration with WebTPA/Communitas teams and external vendors:
  
  Facilitates timely and open communication with clinical staff departments, internal and external customers.
  
  Work collaboratively and cross-functionally with internal and external teams.
  - Daily interventions between Operation and Clinical teams to ensure proper handling of claims issues / customer service
  requests / member portal requests - that they are assigned to Ops team to assist and resolve when appropriate.
  - Assist CACs with higher-level decisions that impact outside teams.
  
  Engage with internal clinical teams and provide feedback from clients to clinical teams.
  
  Work with clinical team leads to analyze, identify, and improve processes within the division, based on client feedback.
  
  Develop strong, trusting relationships with assigned groups, agents, consultants, and brokers for continued client retention. (15%)
• Other:
  
  Assist leadership team in guiding the work of the Clinical Management teams, as deemed appropriate.
  
  Mentor future hires to this role, as the program grows.
  
  Oversight of assigned Clinical Account Managers as they assist with client-specific directives.
  
  Attend Monthly Managers of People Meeting (WebTPA) - virtually, if not an in-office employee. (5%)

Required Work Experience
7+ years related work experience. Experience Details: Direct Clinical Care, Healthcare Operations, or Clinical Account Management
Experience in payer-side roles or client-facing healthcare preferred

Required Management Experience
2+ years direct supervisory/management experience

Required Education
High school diploma or GED Associate's degree or higher is preferred
Equivalent combination of education and extensive experience in clinical account management or healthcare operations will be considered.

Required Licenses and Certifications
Active clinical license required (e.g., LVN, RN, LCSW, PA, PT, OT, ST).
Additional certifications (e.g., CCM) are a plus.
Nursing or other Clinical Compact License required if state of residence participates in a Compact.

Additional Required Qualifications

Extensive experience and demonstrated proficiency in all MS Office applications including Word, Excel, Access and PowerPoint.

Strong verbal and written communication skills. Writing samples may be requested as proof.

Comfortable working and communicating across operational areas within the organization.

Can appropriately handle confidential and sensitive information.

Ability to present to clients and executives in a confident manner.

Managing the message to the intended audience consistent with business objectives

Negotiation skills.

Superior client service attitude coupled with excessive energy and enthusiasm.

Strong desire to succeed in conjunction with a highly developed work ethic.

Extremely driven with the ability to self-manage.

High attention to details; particularly those driving benefit plan performance.

Ability to work independently/autonomously and proactively as well as collaboratively as a member of a team.

Analysis - ability to identify problems/issues and propose high-performing solutions.

Ability to segment and prioritize workload based on time sensitivities and critical success factors.

Well-developed project management skills.

Preferred Licenses and Certifications
CCM - Certified Case Manager 1 1/2 Yrs

Additional Preferred Qualifications
Previous Managerial/Director-level experience in healthcare setting preferred.
Previous experience with Regulatory Compliance and/or URAC/NCQA Accreditation is beneficial.

General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities
Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Frequently

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.