Job Description

Clinical Consultant- Government Programs

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Clinical Consultant- Government Programs is responsible for identifying potential emerging customer needs and promotes innovative solutions to meet them. Solves unique and complex problems with broad impact on the business. Participates in the development of business strategy and supports complex projects to achieve key business objectives. They will translate highly complex concepts in ways that can be understood by a variety of audiences, influence senior leadership to adopt new ideas, products and/or approaches and direct cross-functional and/or cross-segment teams.

Youll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Support development of clinical models for complex populations governmental programs, i.e. Medicare Advantage and DSNP based on the assigned market
• Resolves highly complex business problems that affect clinical processes and functional requirements
• Ensures local care delivery is in compliance with all Governmental payor, State, Federal, NCQA and contractual requirements through implementation/recommendation of appropriate quality controls, checks and balances
• Serves as a Clinical SME for external and internal Leaders regarding governmental programs, i.e. HCBS WAIVER, ABD, TANF/CHIP
• Promotes regulatory compliance processes and change management on all assigned programs and initiatives
• Participates in the development and maintenance of clinical policies, procedures, SOPs, Job Aids, reporting and assessment tools as applicable to clinical value programs
• Prepares documents and reports for leadership reports, program status reports & compliance updates
• Develop Executive level updates and reports
• Participate in the development of measurable business and affordability goals
• Identifies and prepares recommendations for cross-functional improvements and opportunities
• Identifies improvements in cross-functional communication process

Youll 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:

• Active RN license
• 5+ years of experience in clinical consulting role, supporting various clinical affordability initiatives in large medical group setting or Health plan
• 4+ years working with Medicare, Medicaid regulatory requirements with Utilization Management, Case Management or Clinical Product Management experience
• Medicare, Medicaid, and Commercial insurance experience with: NCQA, URAC, state & federal regulatory requirements
• Experience developing and executing strategies for functions or disciplines that span a large business unit or multiple markets/sites
• Experience with Program Development and Management, including development of strategic initiatives, active implementation, post implementation management and execution
• Advanced proficiency in Microsoft applications
• Willing to travel up to 50%

All employees working remotely will be required to adhere to UnitedHealth Groups Telecommuter Policy.

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Maryland, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $104,700 to $190,400 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

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 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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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

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