Clinical Program Manager, Commercial Markets IV

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We’re a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration – because success is a team sport. It’s our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Clinical Program Manager – Commercial Market Division is a key contributor communicating clinical performance to commercial customers of Medica and helping to design solutions to meet the clinical and population health needs of our employer and broker customers. Strong relationship management skills are critical for this role as are strong presentation skills. This role operates in a highly matrixed environment, partnering with Commercial Sales & Retention, Commercial Product, Markets, and Enterprise Analytics.

• Review, analyze, and communicate population performance data for employers
  • Provide insights and clinical recommendations to both internal account team and external employer customers around clinical performance, performance trends, future trends/pipeline and wellness/clinical solution recommendations.
  • Analyze and present clinical data in partnership with commercial employer account team and enterprise analytics. Support market strategy through clinical and financial analytics. Ability to use self‑service reporting.
  • Develop insights into clinical performance and opportunities for a given employee population.
  • Participate in development of clinical strategy for larger/more strategic accounts.
• Support in matrixed environment
  • Responsive support for commercial accounts team, providing clinical insights from reporting, including regular cadence of review and notification of new high‑cost claimants.
  • Serve as a resource on commercial product options for the sales and account teams.
  • Understand local market business dynamics and incorporate these into analysis.
• Facilitate adoption of personalized employer wellness programs
  • Deep understanding of wellness and vendor programmatic options available to support employers, and also the specific details of selections and rationale for wellness options.
  • Consulting-like service including creating personalized wellness strategies for employers using the products available in our ecosystem.
  • Ambassadorship of commercial market strategy around product offerings and key strategies.
• Presentations
  • Professional presentations to current and prospective customers (including C‑suite) and their brokers.
  • Include RFPs/ finalist presentations in addition to periodic performance data.
  • Align with Medica’s approaches to presenting data and clinical analytics approach.

• Bachelor’s degree in Nursing, Public Health or related clinical field;
  Master’s degree or MBA helpful preferred.
• 7+ years of relevant work experience.

• Clinical experience required.
• Broad knowledge of managed care, the healthcare industry and health plan care management functions; knowledge of state/federal health insurance regulations beneficial, however not required.
• Experience and skill in using Excel, and other BI tools like Qlik Sense and Power BI.
• Experience in building and delivering effective presentations.
• Strong analytical skills.
• Experience reviewing clinical utilization and performance data for potential opportunities.
• Develop and maintain knowledge of market dynamics and business strategies.
• Demonstrated experience delivering results in an ambiguous and changing environment.
• Demonstrated success with project management, leadership, and implementation.
• Creative problem‑solving skills, adaptability, and strong communication skills.

This position is an office role, which requires an employee to work onsite at our Madison, WI office, on average, 3 days per week.

The full salary grade for this position…