Description

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

This position is part of the Value Creation - Genomics & Laboratory Team. Value Creation Teams are responsible for comprehensive affordability strategy development, direction, and execution within a category. Teams focus on utilization management, quality improvement, and improved provider and member experience.

As a Senior Clinical Program Consultant, you will play a key role in program ideation, design, implementation, operations, and ongoing monitoring of genomic and laboratory testing programs. This role requires deep knowledge of genetic and molecular testing methodologies, the evolving genomics market, CPT coding, and the claims life cycle, along with solid analytical, strategic, and problem-solving skills. This role also requires familiarity with professional and facility claim processing, including but not limited to claim edits, coordination of benefits, claim reprocessing, as well as experience and knowledge of UnitedHealthcare's enterprise claim systems. This is a high-impact opportunity for a self-starter who thrives on driving meaningful change, collaborating across teams, and leading thoughtful execution of strategies.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Direct and support the build out of new infrastructure, processes, and tools necessary to deploy DEX Z-Code® program initiatives
• Develop processes, standards, tools, and documentation to support timely, accurate data reporting for genomic and laboratory testing programs, specifically focusing on the DEX Z-Code® program and the Genetic and Molecular Prior Authorization/Advanced Notification program
• Build system tools/enhancements to support early detection of issues, alert mechanisms, established processes for issue resolution, and monitoring to ensure operational excellence
• Leverage processes/tools to monitor program performance in real-time, creating monthly outcome reports
• Manage claims analysis, research, and resolution facilitation - analyze claims examples and trends to identify root cause and lead development of timely solutions
• Lead claims projects and other special projects, as needed; develop and distribute claims flow documentation, validate claims edit hierarchy, and assess the operational impact
• Serve as a thought leader for technical business processes that promote increased efficiency
• Collaborate with internal teams, including but not limited to product, program, IT, clinical, payment integrity, legal, regulatory, compliance, networks, payment policy, and others to ensure alignment
• Identify and implement process improvements to optimize efficiency, compliance, and provider/member experience

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• 6+ years of experience in clinical program management, utilization management, payment integrity, healthcare operations, or related experience
• 3+ years claims systems experience
• Proven expertise in genetic and molecular testing and the associated CPT codes, billing processes, and claims adjudication
• Intimate understanding of UHC claims platforms
• Advanced proficiency with data analysis and interpretation, using insights to improve program performance
• Proficient with Microsoft Office (Excel, Word, PowerPoint), SharePoint, Visio, OneNote, PowerBI
• Proven solid communication and presentation skills, including the ability to translate complex genomic concepts into business and policy strategies

Preferred Qualifications:

• 7+ years of experience in clinical program management, utilization management, payment integrity, healthcare operations, or related experience
• Managed care experience
• Advanced proficiency with MS Office (Excel, Word, PowerPoint, SharePoint, Visio, OneNote, PowerBI)
• Proficiency in Smartsheet for tracking and managing operational data
• Proven ability to manage complex programs and initiatives in a matrixed environment
• Proven ability to take initiative and drive change - a self-starter who thrives on problem-solving

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 to $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Requisition #: 2337114

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Requirements