Job Description

Job Description

Job Description

Job Description

Company Overview:

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team, from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It's no wonder 98% of patients report being fully satisfied with Upward Health!

Job Title & Role Description:

The Clinical Solution Specialist is responsible for the design, implementation, and evaluation of clinical care programs that improve patient outcomes, support value-based care initiatives, and align with organizational goals. This role serves as a subject matter expert bridging clinical expertise and operational strategy, working closely with cross-functional teams including clinical operations, quality, technology, and business development. The Specialist brings deep knowledge of care delivery models and leverages data to inform the creation of scalable, patient-centered solutions across various populations and care settings.

Initially, this role will be acutely focused on improving clinical, quality, and safety outcomes for adult and pediatric populations and patients experiencing transitions of care from emergency departments, inpatient settings, or other tertiary settings back to the home environment. This role works alongside a team of doctors, pharmacists, nurses, social workers, nurse practitioners, and clinical services leaders to develop evidence-based clinical solutions, quality improvement strategies, design patient care models, assess health risk outcomes, and facilitate cross-functional collaboration.

The ideal candidate will have deep experience building pediatric and adult programs, including creating workflows for pediatric and family assessments, care coordination, and social risk factor mitigation. In addition, this candidate will have extensive knowledge on Transitions of Care, including background in creating safe and effective care transitions through workflows for engaging patients at admission and discharge, discharge assessments, coordinating provider follow-up visits, and implementing nursing-led transition planning to reduce risk of readmissions.

The Clinical Solution Specialist will have advanced knowledge and expertise in pediatric clinical program development and transitions of care workflows, with a broad understanding of population health, quality improvement, and team-based care models. Experience addressing social determinants of health in pediatric settings is valuable, while this role also emphasizes a holistic, clinical approach to care delivery transformation.

Skills/Requirements:

• Nursing degree (BSN or higher preferred); RN license required
• Must have pediatric experience
• Minimum 3 years of experience in clinical care delivery, care management, or clinical program design. Experience in value-based care or population health strong preferred
• Project Management certification, lean six sigma, and/or other related certifications preferred
• Proficiency in project management tools and methodology
• Prior experience building adult and pediatric programs and workflows (e.g., patient assessments, family environment assessments, developmental screening, patient care coordination)
• Strong understanding of care delivery across diverse populations and settings (e.g., ambulatory, post-acute, home health, etc.)
• Familiarity with social determinants of health and how they impact patient care delivery
• Experience developing workflows and care models with clinical and non-clinical teams
• Proficiency in Electronic Medical Record (EMR) software and workflow documentation
• Clinical education and training experience (especially for nurses and care teams)
• Understanding of Medicare and Medicaid reimbursement structures
• Ability to travel to various Upward Health markets as needed
• Competent in Microsoft Office Suite and Visio for process design

Key Behaviors:

Collaboration & Teamwork:

• Collaborates with internal stakeholders (e.g., providers, care team members, quality teams, etc.) to ensure solutions are clinically sound and operationally viable.
• Actively listens to team members and stakeholders and integrates their feedback into Solution development.

Problem Solving & Decision Making:

• Uses data analysis and clinical insights to inform decisions and develop effective solutions for improving Solution outcomes.
• Demonstrates the ability to identify issues, assess risks, and implement corrective actions.

Communication & Influence:

• Communicates complex clinical concepts clearly to both internal and external stakeholders.
• Influences care teams by presenting evidence-based rationales for workflow designs and updates.
• Demonstrates active listening and empathy, particularly in engaging with patients or healthcare professionals regarding behavioral health and substance use issues.
• Effectively presents training materials and Solution updates to a variety of audiences, including patients, providers, and interdisciplinary teams.

Adaptability & Flexibility:

• Adapts to changes in clinical solution needs, evolving best practices, regulatory or contractual requirements, or stakeholder expectations.
• Willingness to adjust to changing schedules and demands, including the flexibility to work occasional nights and weekends.

Attention to Detail:

• Reviews medical records and clinical data with high attention to accuracy and compliance with regulations and standards (e.g., HEDIS measures, HIPAA).
• Ensures thorough documentation and synthesis of patient and solution data for reporting.

Leadership & Accountability:

• Takes ownership of the development and ongoing refinement of clinical solutions.
• Responsible for meeting quality improvement metrics and patient outcomes associated with their solutions.
• Demonstrates leadership in clinical Solution training, ensuring all involved parties are educated on key aspects of the solution.

Patient-Centered Care:

• Prioritizes child and family-centered care in the design of clinical programs.
• Ensures that patient feedback and real-life outcomes are incorporated into the clinical solution's evolution.

Efficiency & Time Management:

• Manages competing priorities and multiple stakeholder demands, ensuring deadlines are met and outcomes are achieved efficiently.
• Organizes workflows and schedules for solution implementation, training, and assessment in an effective manner.

Competencies:

Clinical Solution Development:

• Lead the design and development of clinical programs and care models that address patient needs across the care continuum.
• Translate clinical insights and evidence-based practices into actionable workflows and program strategies.
• Expertise in designing pediatric and transitions of care workflows with a focus on reducing readmissions, enhancing care continuity, and improving family engagement.
• Ability to analyze patient data to identify opportunities for solution enhancements.

Pediatric Care Knowledge:

• Deep understanding of pediatric developmental needs, assessments, and care coordination best practices.
• Knowledge of care delivery across the pediatric continuum, including integration with family systems.

Transitions of Care:

• Demonstrated experience designing workflows that support safe transitions out of emergency or inpatient settings.
• Skilled in implementing discharge planning protocols, follow-up visit scheduling, and risk-reduction strategies for readmission.

Social Determinants of Health (SDoH):

• Awareness of how social and environmental factors impact pediatric and family health outcomes.
• Ability to integrate SDoH into care coordination and referral pathways, especially for vulnerable pediatric populations.

Regulatory Compliance & Accreditation:

• Proficiency in pediatric and transition-related regulatory guidelines and quality standards (e.g., HEDIS, NCQA).
• Ensures audit readiness and documentation compliance across solutions.

Data Analysis & Reporting:

• Evaluate program effectiveness using clinical, operational, and financial data; recommending and implementing improvements.
• Skilled in collecting, analyzing, and synthesizing clinical data, including health outcomes, patient satisfaction, and quality metrics.
• Proficient in creating actionable reports and presenting findings to leadership.

Training & Education:

• Experience in creating training content and delivering educational Solutions for both clinical and non-clinical team members.
• Ability to assess learning needs and deliver customized training solutions to diverse audiences.

Project Management:

• Familiar with project management tools and methodologies to plan, execute, and monitor the progress of clinical solution initiatives.
• Experience in coordinating timelines, resources, and stakeholder engagement to ensure the successful rollout of solutions.

Technology Proficiency:

• Competence with Electronic Medical Records (EMR) systems and familiarity with healthcare-related software to enhance Solution delivery and data tracking.
• Experience with Salesforce or similar CRM systems a plus.
• Ability to utilize technology to improve solution outcomes and operational efficiency.

Quality Improvement (QI):

• Knowledge implementing quality improvement initiatives.
• Familiar with measuring and reporting on quality metrics, including those related to patient safety, clinical outcomes, and solution effectiveness.

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.

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