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Senior Clinical Program Consultant - Telecommute

Company: UnitedHealth Group
Location: Eden Prairie
Posted on: January 12, 2022

Job Description:

Do you have compassion and a passion to help others? -Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve -your life's best work.(sm)Positions in this function are responsible for the development and/or on-going management and administration of clinical value programs and other clinical programs within OptumCare. The position provides implementation support, measurement standards, and revisions as needed that incorporate applicable best practices with proven outcomes. The position will be required to work in a highly matrix organization, it will be focused on implementing value based solutions in a diverse population of care providers.This position will be critical to supporting new market readiness for medical management and the medical expense affordability target. As such, the hiring leaders are seeking someone who has specific experience in supporting various clinical affordability initiatives in a large medical group setting or Health plan and will ask for specific examples of affordability initiatives or programs that you have supported. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. -Primary Responsibilities:

  • Resolves highly complex business problems that affect clinical processes and functional requirements
  • As applicable, ensures local care delivery is in compliance with all payor, State, Federal, NCQA and contractual requirements through implementation/recommendation of appropriate quality controls, checks and balances
  • Determines metric and baseline measures for affordability and process change outcomes/controls
  • Assists in the development of any required reporting and monitoring assessments
  • Identifies operational reports, compliance reports, dashboards, and guides others on interventions and suggested improvements
  • 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
  • Upon request - Prepares documents and reports for leadership reports, program status reports & compliance updates
  • Upon request - develop Executive level updates and reports
  • Participate in the development of measurable business and affordability goals
  • Identifies and prepares recommendations for cross-functional/cross CDO process improvements and opportunities
  • Identifies improvements in cross-functional communication processJob Scope and Guidelines:
    • Identifies 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
    • Supports complex projects to achieve key business objectives
    • Translates highly complex concepts in ways that can be understood by a variety of audiences
    • Influences senior leadership to adopt new ideas, products and/or approaches
    • Directs cross-functional and/or cross-segment teamsYou'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:
      • Undergraduate degree in Nursing, Healthcare Administration or other Health Related field
      • Active RN license
      • 5+ years of -experience in clinical consulting role, supporting various clinical affordability initiatives in large medical group setting or Health plan -
      • Experience developing and executing strategies for functions or disciplines that span a large business unit or multiple markets/sites
      • Broad understanding of Medicare, Medicaid regulatory requirements with Utilization Management, Case Management or Clinical Product Management experience
      • Experience with Program Development and Management, including development of strategic initiatives, active implementation, post implementation management and execution
      • Medicare, Medicaid, and Commercial insurance experience with:
        • Knowledge of NCQA, URAC, state & federal regulatory requirements
        • Advanced proficiency in Microsoft applications
        • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all -federal, state -and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to -employment to ensure compliancePreferred Qualifications:
          • Master's Degree -(or equivalent experience if degree is in a different focus)
          • 5+ years of -leadership/management experienceUnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.Careers with Optum. -Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do -your life's best work.(sm)OptumCare -is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.Colorado Residents Only: -The salary range for Colorado residents is $94,500 to $171,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentivesDiversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.Job Keywords: - -Senior Clinical Program Consultant, -Telecommute, Remote, Work from Home

Keywords: UnitedHealth Group, Eden Prairie , Senior Clinical Program Consultant - Telecommute, Healthcare , Eden Prairie, Minnesota

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