Senior Clinical Consultant

Job Description

Job Description

We are seeking an experienced and strategic  Senior Clinical Consultant  with deep experience in Utilization Management (UM) for  Intellectual and Developmental Disabilities (IDD) ,  Behavioral Health (BH) , and  Home and Community-Based Services (HCBS) . This role involves partnering with healthcare organizations to assess, design, implement, and optimize clinical processes, systems, and programs. The ideal candidate has hands-on experience in community-based care models, understands person-centered planning, and is passionate about improving care outcomes for vulnerable and underserved populations and a proven track record in clinical consulting or health systems improvement.  The ideal candidate combines strong clinical expertise with operational insight into Medicaid-funded community-based services.

Essential Functions / Key Responsibilities :

• Collaborate with clients to assess current clinical workflows, quality initiatives, and care delivery models for BH, IDD & HCBS populations.
• Lead strategic consulting engagements focused on transforming UM functions across IDD, BH, and HCBS systems.
• Conduct needs assessments and gap analyses of clinical service models across residential, day, and community-based settings.
• Design and implement strategies to improve clinical outcomes, patient safety, and operational efficiency.
• Analyze current UM processes, clinical review workflows, and decision-making frameworks to identify inefficiencies and areas for improvement.
• Design person-centered outcomes-based UM models that align with Medicaid regulations, waiver authorities, and the HCBS Final Rule.
• Develop clinical criteria and review protocols tailored to community-based and residential services for complex populations.
• Support the implementation of electronic utilization management systems and ensure integration with case management and care coordination functions.
• Create training documents for UM clinicians and reviewers on evidence-based review standards, level of care criteria and documentation best practices.
• Evaluate UM performance data, identify trends (e.g., over / under-utilization), and recommend corrective actions to support quality and cost-effectiveness.
• Collaborate with compliance and policy teams to ensure adherence to federal and state regulatory requirements.
• Contribute clinical insight to RFP responses, program evaluations, and strategic planning for clients in the public and private sectors.
• Analyze clinical data to identify trends, opportunities, and areas for performance improvement.
• Lead clinical workstreams for projects related to waivers and integrated care delivery.
• Serve as a subject matter expert (SME) in clinical best practices, regulatory compliance, and care standards.
• Provide subject matter expertise on person-centered planning, functional assessments, behavior support plans, and trauma-informed care.
• Lead clinical workstreams in projects involving EHR optimization, population health, or care transformation.
• Translate clinical, regulatory, and policy requirements into actionable implementation plans for systems and provider organizations.
• Train and coach provider staff, care coordinators, and system leaders on clinical best practices, evidence-based interventions, and service planning.
• Collaborate with cross-functional teams (e.g., policy, data, operations) to support transformation initiatives and ensure compliance with federal and state guidelines.
• Contribute to business development efforts by supporting proposal writing, client presentations, and strategic planning.

Competencies :

Travel :

Required education and experience :

Preferred  education, certifications and / or experience :

Physical Requirements / Work environment :

Other duties :

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and / or activities may change at any time with or without advanced notice.