Clinical Subject Matter Expert; SME

Overview

Clinical Subject Matter Expert (SME)

Health Edge is transforming how health plans operate. Our Guiding Care 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.

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 Guiding Care is configured and utilized to its fullest potential. This is a journey-level, fully qualified individual contributor role offering significant autonomy and impact.

Our Care Solutions team unites the powerful capabilities of Guiding Care and Wellframe to transform care delivery and member engagement in healthcare. Guiding Care 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.

• Lead discovery sessions to elicit, document, and translate detailed clinical and workflow requirements into actionable Guiding Care configurations, ensuring alignment with applicable regulatory and accreditation standards
• Design and deliver clinical workflows utilizing Guiding Care 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 Guiding Care 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

• 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

• Experience with care management platform implementations
• Familiarity with NCQA, URAC, CMS, or HEDIS…