Remote Clinical Program Consultant Jobs
Remote clinical program consultant jobs are open across the U.S. at remote-first health organizations, managed care companies, and distributed life sciences teams. Employers hiring remote clinical program consultants right now include CogState, Norstella, and Rightway Healthcare. Scan the live roles below and apply to whichever ones fit.
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Showing 5 of 7+ Remote Clinical Program Consultant jobs
Your Role
The Commercial CMO Team provides clinical oversight for programs and processes that support members’ health care, reduce costs, and improve quality. The Program Manager Clinical, Consultant (Line of Business) reports to the Director of Program Management, Clinical – CMO. In this role, you will analyze clinical and financial data to identify trends and opportunities to improve care and manage costs for employer-funded health insurance, lead projects to address these opportunities and develop presentations that clearly communicate the clinical insights and recommended actions. You will also facilitate meetings with internal and external stakeholders and drive improvements in healthcare cost trends through both direct interventions and broader, system-level initiatives.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Work
In this role, you will:
Provide analysis, leadership, and guidance, for a given line of business, including opportunity identification, business case creation, and implementation
Provide steady leadership in the face of uncertainty, change, and aggressive deadlines common to a rapidly growing company with an evolving business model
Create presentations and manage meeting requests at a high level.
Lead cross-functional meetings and foster teamwork; drive escalation and resolution of issues, while promoting collaboration and coordination across broad categories of stakeholders
Collaborate with analytics, actuarial, and quality teams to develop, analyze, and distribute reports, and document program activities, interventions, and outcomes
Perform deep-dive analysis of high-cost claims, vendor-identified populations, and other defined groups, producing case studies, reports and presentations
Research and recommend interventions; identify and drive improvements and actions to significantly impact the cost of healthcare.
Conduct detailed reviews of high-cost claims and episodes of care to identify actionable cost-saving opportunities, including site-of-care optimization, inappropriate utilization, claims payment integrity issues, contractual compliance, and coordination of benefits
Analyze inpatient admissions, readmissions, specialty drug utilization, and high-cost professional and facility claims to identify key drivers of healthcare trend and develop targeted mitigation strategies
Identify opportunities for site-of-service steerage, provider network optimization and out-of-network utilization management, care management interventions, and benefit design enhancements to reduce total cost of care
Monitor emerging healthcare cost drivers, including specialty pharmaceuticals, oncology, behavioral health, specialist and emergency department utilization, and recommend appropriate interventions
Measure and communicate intervention outcomes, including savings realized, quality impacts, operational effectiveness, and member experience considerations
Partner closely with analytics teams to develop, analyze and distribute reporting
Liaise with analytics and cost of healthcare groups across the enterprise to compare trends, share knowledge, and measure outcomes
Organize and lead cross-functional meetings, foster teamwork and collaborative problem-solving across diverse stakeholders
Facilitate cross-functional taskforces with specific cost of healthcare commitments
Other duties as assigned
Your Knowledge and Experience
Requires a Bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree and a completion of an accredited educational program that meets the requirements for applicable professional license
Requires at least 7 years of prior relevant experience
Requires current California LVN, RN, NP, or PA license
Prefers familiarity with health care data and the health care delivery system in California; health plan or provider experience strongly desired
Strong organizational and/or project management skills, consistent ability to “self-start” and take ownership of end-to-end taskforce activities
Excellent written and oral communication skills, ability to facilitate cross-functional discussions, lead teams through influence to drive actions and outcomes
Experience in cost of health care analysis, population health outcomes, and/or program evaluation desired
Expertise in analyzing high-cost claims, episodes of care, and healthcare cost drivers to identify opportunities for medical cost reduction desired
Ability to review complex claims for payment accuracy, contractual compliance, coordination of benefits, and potential payment integrity issues desired
Prefers knowledge of provider reimbursement methodologies, including DRG, case rate, per diem, percentage-of-charge, and letter-of-agreement arrangements
Experience identifying fraud, waste, abuse, upcoding, unbundling, inappropriate billing, and other claim-payment vulnerabilities desired
Experience performing root-cause analyses of trend drivers and developing business cases for cost-of-care interventions desired
Strong proficiency using data visualization and analytical tools such as Power BI and other reporting platforms to communicate findings and recommendations
Experience working with employer fully insured and self-insured populations, large group accounts, and multidisciplinary stakeholder groups
Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
ABOUT THE TEAM
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!
Our Values:
- Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
For most teams, this means coming into the office two days per week.
Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
Your Role
The Commercial CMO Team provides clinical oversight for programs and processes that support members’ health care, reduce costs, and improve quality. The Program Manager Clinical, Consultant (Line of Business) reports to the Director of Program Management, Clinical – CMO. In this role, you will analyze clinical and financial data to identify trends and opportunities to improve care and manage costs for employer-funded health insurance, lead projects to address these opportunities and develop presentations that clearly communicate the clinical insights and recommended actions. You will also facilitate meetings with internal and external stakeholders and drive improvements in healthcare cost trends through both direct interventions and broader, system-level initiatives.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Work
In this role, you will:
Provide analysis, leadership, and guidance, for a given line of business, including opportunity identification, business case creation, and implementation
Provide steady leadership in the face of uncertainty, change, and aggressive deadlines common to a rapidly growing company with an evolving business model
Create presentations and manage meeting requests at a high level.
Lead cross-functional meetings and foster teamwork; drive escalation and resolution of issues, while promoting collaboration and coordination across broad categories of stakeholders
Collaborate with analytics, actuarial, and quality teams to develop, analyze, and distribute reports, and document program activities, interventions, and outcomes
Perform deep-dive analysis of high-cost claims, vendor-identified populations, and other defined groups, producing case studies, reports and presentations
Research and recommend interventions; identify and drive improvements and actions to significantly impact the cost of healthcare.
Conduct detailed reviews of high-cost claims and episodes of care to identify actionable cost-saving opportunities, including site-of-care optimization, inappropriate utilization, claims payment integrity issues, contractual compliance, and coordination of benefits
Analyze inpatient admissions, readmissions, specialty drug utilization, and high-cost professional and facility claims to identify key drivers of healthcare trend and develop targeted mitigation strategies
Identify opportunities for site-of-service steerage, provider network optimization and out-of-network utilization management, care management interventions, and benefit design enhancements to reduce total cost of care
Monitor emerging healthcare cost drivers, including specialty pharmaceuticals, oncology, behavioral health, specialist and emergency department utilization, and recommend appropriate interventions
Measure and communicate intervention outcomes, including savings realized, quality impacts, operational effectiveness, and member experience considerations
Partner closely with analytics teams to develop, analyze and distribute reporting
Liaise with analytics and cost of healthcare groups across the enterprise to compare trends, share knowledge, and measure outcomes
Organize and lead cross-functional meetings, foster teamwork and collaborative problem-solving across diverse stakeholders
Facilitate cross-functional taskforces with specific cost of healthcare commitments
Other duties as assigned
Your Knowledge and Experience
Requires a Bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree and a completion of an accredited educational program that meets the requirements for applicable professional license
Requires at least 7 years of prior relevant experience
Requires current California LVN, RN, NP, or PA license
Prefers familiarity with health care data and the health care delivery system in California; health plan or provider experience strongly desired
Strong organizational and/or project management skills, consistent ability to “self-start” and take ownership of end-to-end taskforce activities
Excellent written and oral communication skills, ability to facilitate cross-functional discussions, lead teams through influence to drive actions and outcomes
Experience in cost of health care analysis, population health outcomes, and/or program evaluation desired
Expertise in analyzing high-cost claims, episodes of care, and healthcare cost drivers to identify opportunities for medical cost reduction desired
Ability to review complex claims for payment accuracy, contractual compliance, coordination of benefits, and potential payment integrity issues desired
Prefers knowledge of provider reimbursement methodologies, including DRG, case rate, per diem, percentage-of-charge, and letter-of-agreement arrangements
Experience identifying fraud, waste, abuse, upcoding, unbundling, inappropriate billing, and other claim-payment vulnerabilities desired
Experience performing root-cause analyses of trend drivers and developing business cases for cost-of-care interventions desired
Strong proficiency using data visualization and analytical tools such as Power BI and other reporting platforms to communicate findings and recommendations
Experience working with employer fully insured and self-insured populations, large group accounts, and multidisciplinary stakeholder groups
Hybrid Virtual Work
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
ABOUT THE TEAM
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!
Our Values:
- Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
For most teams, this means coming into the office two days per week.
Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
See All 7 Remote Clinical Program Consultant Jobs
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Who's Hiring
Top Industries Hiring
- Technology & Software
What Employers Look For
The qualifications that appear most often in remote clinical program consultant jobs.
- Active clinical license such as RN, LCSW, or equivalent required
- Experience in managed care, utilization management, or case management settings
- Proficiency with electronic health records and care management platforms
- Knowledge of NCQA, HEDIS, or other clinical quality measurement frameworks
- Strong ability to communicate clinical recommendations to non-clinical stakeholders
- Bachelor's degree in nursing, social work, public health, or a related clinical field
Tips for Your Remote Clinical Program Consultant Job Search
Show async communication skills upfront
Remote clinical program consultant roles depend on written communication more than in-person ones do. Include writing samples, program briefs, or summary reports in your application materials so hiring managers can judge your clarity before an interview.
Highlight distributed program management experience
Remote employers want proof you've coordinated clinical programs across multiple sites or teams without being physically present. Call out specific programs you managed remotely, the stakeholders involved, and how you kept work on track using tools like project trackers or shared documentation platforms.
Apply early to remote roles that fit
Migrate Mate lists remote clinical program consultant openings from across the U.S. in one place, so you can find roles that match your background and apply directly without sorting through listings that aren't actually remote.
Prepare for structured remote interviews
Remote clinical program consultant interviews often run entirely over video and include scenario-based questions about program design, stakeholder communication, and outcome measurement. Practice walking through a real program you shaped from start to finish so your answers are concrete, not theoretical.
Remote Clinical Program Consultant Jobs: Frequently Asked Questions
How do I get a remote clinical program consultant job?
Target remote-first health plans, digital health companies, and distributed managed care organizations that run clinical programs across multiple sites and need consultants who can operate independently. Remote employers screen heavily for async written communication, self-directed project management, and clinical program knowledge you can demonstrate without in-person oversight. A portfolio of programs you've designed, evaluated, or improved gives you a concrete edge over candidates who list skills without evidence.
Which companies hire remote clinical program consultants?
Companies hiring remote clinical program consultants right now include CogState, Norstella, and Rightway Healthcare, based on current remote listings on Migrate Mate as of November 2026. Remote openings for this role concentrate at health insurers, population health firms, and digital health platforms that run distributed clinical operations teams.
Can you get a remote clinical program consultant job with no experience?
Yes, but remote entry-level roles are harder to land because employers expect you to work independently from day one with minimal supervision. Entry paths include health plan internships, clinical quality improvement projects, or care coordination work that shows program-level thinking. Demonstrating strong written communication and familiarity with clinical program frameworks can substitute for years of direct experience with many remote-first organizations.
Do you need a degree for remote clinical program consultant jobs?
Usually, but the field that matters more than the credential level. Remote employers in this space typically want a background in nursing, public health, healthcare administration, or a related clinical field. What carries real weight alongside a degree is documented experience managing or improving clinical programs, strong analytical skills, and the ability to communicate findings clearly in writing without face-to-face interaction.
Which industries hire the most remote clinical program consultants?
Most remote clinical program consultant openings sit in Technology & Software, per current remote listings on Migrate Mate as of November 2026. These sectors hire clinical program consultants remotely because their programs operate across geographically distributed member or patient populations that don't require on-site program management.
See All 7 Remote Clinical Program Consultant Jobs
Find roles that match your experience and apply in just a few clicks.
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