Job Details

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.Primary ResponsibilitiesDirect and support the build out of new infrastructure, processes, and tools necessary to deploy DEX Z‑Code® program initiativesDevelop 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 programBuild system tools/enhancements to support early detection of issues, alert mechanisms, established processes for issue resolution, and monitoring to ensure operational excellenceLeverage processes/tools to monitor program performance in real‑time, creating monthly outcome reportsManage claims analysis, research, and resolution facilitation – analyze claims examples and trends to identify root cause and lead development of timely solutionsLead claims projects and other special projects, as needed; develop and distribute claims flow documentation, validate claims edit hierarchy, and assess the operational impactServe as a thought leader for technical business processes that promote increased efficiencyCollaborate with internal teams – product, program, IT, clinical, payment integrity, legal, regulatory, compliance, networks, payment policy, and others – to ensure alignmentIdentify and implement process improvements to optimize efficiency, compliance, and provider/member experienceRequired Qualifications6+ years of experience in clinical program management, utilization management, payment integrity, healthcare operations, or related fields3+ years claims systems experienceProven expertise in genetic and molecular testing and the associated CPT codes, billing processes, and claims adjudicationIntimate understanding of UHC claims platformsAdvanced proficiency with data analysis and interpretation, using insights to improve program performanceProficient with Microsoft Office (Excel, Word, PowerPoint), SharePoint, Visio, OneNote, PowerBIProven solid communication and presentation skills, including the ability to translate complex genomic concepts into business and policy strategiesPreferred Qualifications7+ years of experience in clinical program management, utilization management, payment integrity, healthcare operations, or related fieldsManaged care experienceAdvanced proficiency with MS Office (Excel, Word, PowerPoint, SharePoint, Visio, OneNote, PowerBI)Proficiency in Smartsheet for tracking and managing operational dataProven ability to manage complex programs and initiatives in a matrixed environmentProven 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 401(k) contribution (all benefits are subject to eligibility requirements). 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.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, protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.#J-18808-Ljbffr