UnitedHealthcare · 13 hours ago
Senior Clinical Program Consultant, Value Creation, Genomics and Lab - Remote
United States
Full-time
Remote
Mid, Senior Level
$113K/yr - $193K/yr
6+ years expUnitedHealthcare is dedicated to simplifying the health care experience and improving community health. The Senior Clinical Program Consultant will be responsible for program ideation, design, implementation, and monitoring of genomic and laboratory testing programs, requiring expertise in genetic testing methodologies and claims processing.
FitnessHealth CareWellness
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
Qualification
Required
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
Preferred
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
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Benefits
Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Company
UnitedHealthcare
UnitedHealthcare helps people live healthier lives by simplifying the health care experience.
10001+ employees
H1B Sponsorship
UnitedHealthcare has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (48)
2024 (26)
2023 (45)
2022 (61)
2021 (60)
2020 (68)
Funding
Current Stage
Late StageLeadership Team
Beth Soberg
CEO West Region, Local Markets
Bobby Gregoire
Medicare Health Plan CEO, Iowa & South Dakota
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