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 equitable. 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 cost, utilization management, quality improvement, revenue maximization, and improved provider and member experience. The Clinical Program Consultant supports clinical programs within the Genomics & Laboratory category. As a Clinical Program Consultant - Genomics and Laboratory, 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 strong 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.
Responsibilities
- Support Genomics and Laboratory Clinical Program Management and Operations
- Support end-to-end program operations ensuring they align with regulatory requirements, clinical best practices, and business objectives
- Address provider, member, and network inquiries related to program operations such as genetic test registration, prior authorization submissions, and claims submissions
- Proactively identify system and operational issues, working with IT and clinical teams to implement sustainable solutions
- Optimize project plans, process flows, and cost-benefit analyses to improve program performance
- Collaborate with internal teams, including but not limited to product, program, medical policy, IT, clinical, payment integrity, special investigations unit, legal, regulatory, compliance, networks, reimbursement policy to ensure smooth program operations
- Support program monitoring and reporting using key performance metrics
- 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 testing methodologies, 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
Requirements
- Bachelor's degree in genetics, molecular biology, public health, healthcare administration, or related field
- 5+ years of experience in managed care including clinical program management, utilization management, medical policy, payment integrity, or related experience
- 1+ years claims systems/reimbursement methodologies experience
- Solid experience with data analysis and interpretation, using insights to improve program operations and inform policy decisions
- Proficiency with MS Office (Excel, Word, PowerPoint, Point)
- Proven expertise in genetic and molecular testing methodologies and their associated CPT codes, billing processes, and claims adjudication
- 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
- Proven ability to take initiative and drive change-a self-starter who thrives on problem-solving
Nice-to-haves
- Project management experience, including leading cross-functional teams and implementing new programs
