Clinical Quality Consultant - Oncogenetic Program - Remote

UnitedHealth Group•Minneapolis, MN

7d•Remote

About The Position

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Clinical Quality Consultant for the Oncogenetic Program provides guidance and support for utilization management related to advanced molecular and genetic testing in oncology. This role ensures evidence-based decision-making, compliance with regulatory standards, and optimal patient outcomes through expert interpretation of genomic data and collaboration with multidisciplinary teams. The position requires experience in molecular pathology and oncogenetics, combined with demonstrated collaboration skills and the ability to thrive in a fast-paced, technology-driven environment. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

PhD degree in molecular pathology, genetics, or similar
5+ years of clinical experience in oncology or genetic medicine
Experience with genomic data interpretation software (e.g., NextGen sequencing analysis tools)
Knowledge of regulatory and compliance standards (CMS, NCCN, ASCO guidelines) for genetic testing and oncology care
Familiarity with molecular diagnostic coding systems and claims platforms
Proficiency in interpreting next-generation sequencing (NGS) and other advanced molecular diagnostic technologies
Proven ability to work effectively in a fast-paced, technology-driven environment
Proven ability to review work performed by others and provide recommendations

Nice To Haves

Hands-on utilization and/or quality management experience
Experience in using electronic clinical systems
Proven to serve as a key resource on complex molecular diagnostic cases

Responsibilities

Work to improve quality and promote evidence-based medicine
Ensure the right service is provided at the right time for each member
Work with medical director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review