Clinical Program Consultant, Genomics and Laboratory - Remote

UnitedHealth Group•St. Louis, MO

8d•Remote

About The Position

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 Clinical Program Consultant - Genomics and Laboratory, you will play a key role in program implementation and operations 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 is a high-impact opportunity for a self-starter who thrives on driving meaningful change, collaborating across teams, and leading innovative clinical programs. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

5+ years of experience in clinical program management, utilization management, payment integrity, healthcare operations or related experience
1+ years of claims systems/reimbursement methodologies experience
Solid experience with data analysis and interpretation, using insights to improve program operations and inform policy decisions
Proven expertise in genetic and molecular testing and the associated CPT codes, billing processes, and claims adjudication
Proficiency with Microsoft Office (Excel, Word, PowerPoint)
Proven ability to manage complex programs and initiatives in a matrixed environment
Proven solid communication and presentation skills, including the ability to translate complex genomic concepts into business and policy strategies

Nice To Haves

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

Responsibilities

Support genomics and laboratory clinical program operations, focusing primarily on the DEX Z-Code® program
Support end-to-end program operations ensuring they align with regulatory requirements, clinical best practices, and business objectives
Address provider, member, and internal stakeholder inquiries related to program operations such as DEX Z-Code registration, quarterly code updates, business rule updates, and claims submissions
Proactively identify system and operational issues, working with IT and clinical teams to implement sustainable solutions
Optimize process flows, claims edit changes, code updates, and triage other operational activities to improve program performance
Draft internal and external program communications
Collaborate with internal teams, including but not limited to product, program, IT, clinical, payment integrity, legal, regulatory, compliance, networks, and payment policy, among others to facilitate unhindered program operations
Identify opportunities for enhancement to existing clinical programs that align with strategic areas of affordability, quality, and access in genomic and laboratory testing
Serve as a subject matter expert (SME) in genetic and molecular laboratory CPT coding and claims processing life cycle across multiple lines of business and across multiple internal teams
Maintain and update utilization management categories for CPT codes specific to genomic and laboratory testing