Clinical Solutions Specialist - General Medicine

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Company Overview: Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team, from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs - everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals - because we know that health requires care for the whole person. It's no wonder 98% of patients report being fully satisfied with Upward Health! Job Title & Role Description: The Clinical Solution Specialist is responsible for the design, implementation, and evaluation of clinical care solutions that improve patient outcomes, support value-based care initiatives, and align with organizational goals. This role serves as a subject matter expert bridging clinical expertise and operational strategy, working closely with cross-functional teams including clinical operations, quality, technology, and business development. The Specialist brings deep knowledge of adult care delivery models and leverages data to inform the creation of scalable, patient-centered solutions across care settings. This role works alongside doctors, nurses, social workers, nurse practitioners, and clinical services leaders to develop evidence-based clinical solutions, quality improvement strategies, patient care models, health risk mitigation approaches, and cross-functional workflows that are clinically sound, operationally feasible, and aligned to adult population needs. The ideal candidate will have deep experience building adult clinical solutions, particularly within General Medicine, Primary Care, chronic condition management, and Clinical Triage. This includes creating workflows that support provider practice operations, nursing-led chronic condition care planning, patient assessments, care coordination, medication and adherence support, and escalation pathways for acute or emerging patient needs. The Clinical Solution Specialist will also bring strong knowledge of transitions of care and readmission avoidance, including workflows for engaging patients during admission and discharge, completing discharge assessments, coordinating timely provider follow-up, supporting nursing-led transition planning, and helping care teams reduce avoidable emergency department visits, hospitalizations, and readmissions. Skills/Requirements: Nursing degree (BSN or higher preferred); RN license required Minimum 3 years of experience in clinical care delivery, care management, or clinical program design. Experience in value-based care or population health strong preferred Project Management certification, lean six sigma, and/or other related certifications preferred Proficiency in project management tools and methodology Prior experience building adult care solutions and workflows Strong understanding of care delivery across diverse populations and settings (e.g., ambulatory, post-acute, home health, etc.) Familiarity with social determinants of health and how they impact patient care delivery Experience developing workflows and care models with clinical and non-clinical teams Proficiency in Electronic Medical Record (EMR) software and workflow documentation Clinical education and training experience (especially for nurses and care teams) Understanding of Medicare and Medicaid reimbursement structures Ability to travel to various Upward Health markets as needed Competent in Microsoft Office Suite and Visio for process design Key Behaviors: Collaboration & Teamwork: Collaborates with internal stakeholders (e.g., providers, care team members, quality teams, etc.) to ensure solutions are clinically sound and operationally viable. Actively listens to team members and stakeholders and integrates their feedback into Solution development. Problem Solving & Decision Making: Uses data analysis and clinical insights to inform decisions and develop effective solutions for improving Solution outcomes. Demonstrates the ability to identify issues, assess risks, and implement corrective actions. Communication & Influence: Communicates complex clinical concepts clearly to both internal and external stakeholders. Influences care teams by presenting evidence-based rationales for workflow designs and updates. Demonstrates active listening and empathy, particularly in engaging with patients or healthcare professionals regarding behavioral health and substance use issues. Effectively presents training materials and Solution updates to a variety of audiences, including patients, providers, and interdisciplinary teams. Adaptability & Flexibility: Adapts to changes in clinical solution needs, evolving best practices, regulatory or contractual requirements, or stakeholder expectations. Wil

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