Senior Clinical Program Consultant, Value Creation, Genomics and Lab - Remote

UnitedHealth Group•St. Louis, MO

22d•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 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. as you take on some tough challenges.

Requirements

6+ years of experience in clinical program management, utilization management, payment integrity, healthcare operations, or related experience
3+ years claims systems experience
Proven expertise in genetic and molecular testing and the associated CPT codes, billing processes, and claims adjudication
Intimate understanding of UHC claims platforms
Advanced proficiency with data analysis and interpretation, using insights to improve program performance
Proficient with Microsoft Office (Excel, Word, PowerPoint), SharePoint, Visio, OneNote, PowerBI
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 MS Office (Excel, Word, PowerPoint, SharePoint, Visio, OneNote, PowerBI)
Proficiency in Smartsheet for tracking and managing operational data
Proven ability to manage complex programs and initiatives in a matrixed environment
Proven ability to take initiative and drive change - a self-starter who thrives on problem-solving

Responsibilities

Direct and support the build out of new infrastructure, processes, and tools necessary to deploy DEX Z-Code® program initiatives
Develop 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 program
Build system tools/enhancements to support early detection of issues, alert mechanisms, established processes for issue resolution, and monitoring to ensure operational excellence
Leverage processes/tools to monitor program performance in real-time, creating monthly outcome reports
Manage claims analysis, research, and resolution facilitation - analyze claims examples and trends to identify root cause and lead development of timely solutions
Lead claims projects and other special projects, as needed; develop and distribute claims flow documentation, validate claims edit hierarchy, and assess the operational impact
Serve as a thought leader for technical business processes that promote increased efficiency
Collaborate with internal teams, including but not limited to product, program, IT, clinical, payment integrity, legal, regulatory, compliance, networks, payment policy, and others to ensure alignment
Identify and implement process improvements to optimize efficiency, compliance, and provider/member experience