Clinical Subject Matter Expert (SME)

Overview

Clinical Subject Matter Expert (SME)

HealthEdge is transforming how health plans operate. Our GuidingCare platform, powers care management, utilization management, and population health programs for health plans nationwide. We are looking for a seasoned Clinical Subject Matter Expert to join our growing Clinical Operations team — someone who brings deep clinical knowledge, a passion for healthcare technology, and the ability to independently drive outcomes for our clients. 

About the Role 

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. 

About Care Solutions: 

Our Care Solutions team unites the powerful capabilities of GuidingCare and Wellframe to transform care delivery and member engagement in healthcare. GuidingCare excels in offering an integrated care management platform that streamlines workflows, enhances collaboration, and drives better health outcomes for members. Wellframe complements this by providing a digital care management solution that connects health plans with their members through personalized resources and support. Care Solutions empowers healthcare organizations with the technology to make smarter, faster decisions while fostering meaningful connections with members. Our Care Solutions create new standards of care management and member support, paving the way for a healthier, more connected future. 

What You'll Do 

• 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 You Bring 

Required 

• 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 

Preferred 

• 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 

HealthEdge commits to building an environment and culture that supports the diverse representation of our teams. We aspire to have an inclusive workplace. We aspire to be a place where all employees have the opportunity to belong, make an impact and deliver excellent software and services to our customers. 

Geographic Responsibility: While HealthEdge is located in Boston, MA you may live anywhere in the US Type of Employment: Full-time, permanent 

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:  

• The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus. 

• Work across multiple time zones in a hybrid or remote work environment. 

• Long periods of time sitting and/or standing in front of a computer using video technology. 

• May require travel dependent on company needs. 

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check.  

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. 

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**The annual US base salary range for this position is $113,000 to $120,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.