Clinical Program Consultant - Process Modernization - Remote in US

UnitedHealth Group•Minnetonka, MN

6d•$91,700 - $163,700•Remote

About The Position

The Clinical Program Consultant will manage complex workflow modernization and operational improvement initiatives across UCS Operations & Implementation. The role leads assigned projects from discovery and requirements development through solution design, implementation readiness, deployment, and post-launch stabilization. The consultant partners with clinical, operations, policy, benefits, coding, configuration, product, technology, regulatory, compliance, and line-of-business teams to improve fragmented and manual processes, strengthen standardization and traceability, and enable measurable, scalable workflows. The position is remote within the United States. The consultant will support modernization efforts involving prior authorization intake and configuration, claims edit configuration, manual workflow digitization, DTQ review automation, clinical coding automation, clinical pre-determination, and competitor policy monitoring. The role includes coordinating requirements validation, testing, change readiness, communications, implementation planning, post-launch issue resolution, and transition to operational ownership, while providing leadership with concise reporting on project progress and outcomes.

Requirements

Experience facilitating cross-functional discovery or working sessions and translating complex operational needs into clear requirements, decisions, and executable workplans.
Demonstrated experience managing complex projects or programs within healthcare, clinical operations, technology, business operations, or another highly matrixed environment.
Demonstrated experience developing project plans and managing milestones, dependencies, risks, issues, decisions, implementation readiness, and executive status reporting.
Demonstrated proficiency using AI tools to support project delivery, workflow analysis, requirements development, documentation, and business-process improvement.
Ability to coordinate clinical, operational, business, and technical stakeholders where accountability and decision-making are distributed.
Solid analytical, problem-solving, written, and verbal communication skills.
Ability to manage multiple interconnected initiatives and competing priorities.

Nice To Haves

PMP, CAPM, Lean, Six Sigma, or comparable project or process-improvement training.
5+ years of experience in project management, program management, workflow improvement, operational transformation, or a related field.
Healthcare payer or managed-care experience.
Experience supporting prior authorization, clinical review, medical policy, coding, claims, benefits, or healthcare configuration processes.
Experience with workflow redesign, process improvement, automation, digitization, or technology-enabled transformation.
Experience managing projects from discovery and requirements through testing, deployment, and stabilization.

Responsibilities

Lead workflow improvement and modernization initiatives from discovery through implementation, stabilization, and transition to operational ownership.
Develop and maintain integrated project plans covering scope, milestones, deliverables, owners, dependencies, decisions, risks, testing, and implementation activities.
Facilitate workflow discovery with business and clinical stakeholders to identify pain points, manual steps, duplicate activities, fragmented handoffs, control gaps, and improvement opportunities.
Translate workflow findings and strategic priorities into requirements, future-state processes, decision points, exception paths, executable workplans, and measurable outcomes.
Coordinate cross-functional delivery across clinical, operations, policy, benefits, coding, configuration, technology, regulatory, compliance, and line-of-business partners.
Establish project cadence, working sessions, status reporting, RAID management, decision tracking, and escalation processes; proactively address critical-path issues affecting scope, schedule, or readiness.
Coordinate requirements validation, testing, change readiness, communications, implementation planning, and post-launch issue resolution.
Provide leadership reporting on project progress, milestones, risks, dependencies, decisions, readiness, and outcomes.
Support modernization efforts involving prior authorization intake and configuration, claims edit configuration, manual workflow digitization, DTQ review automation, clinical coding automation, clinical pre-determination, and competitor policy monitoring.