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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

As a Clinical Consultant in the Clinical Sciences Institute, you are part of a dynamic team committed to supporting Optum’s Centers of Excellence programs. You will interact with physician medical directors, network contract and product development teams, case managers, and project managers. You will perform a variety of work activities including researching and writing clinical utilization management guidelines, plan and convene panels of external clinical experts, support the development of new Optum products by performing literature reviews and creating medical code sets for claims analysis, and contribute to decisions concerning the quality of care delivered to Optum members and clients by programs in our Centers of Excellence. The candidate for this position is someone who adapts quickly to changing priorities and is ready for new learning.

You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Clinical leadership of assigned Optum products, including:
  • Research and development of product-specific clinical utilization management guidelines including annual literature/evidence reviews and shepherding the guidelines through the marketing and publication processes
  • Research and development of selection criteria for products with a centers of excellence (COE) network including annual literature/evidence reviews
  • Planning and execution of annual expert panel for assigned Optum products
  • Contribute to decision-making during annual network qualification for assigned Optum products including clinical evaluation of COE network status appeals and quality outcome reviews
  • Conduct quality of care investigations of adverse member outcomes/events at programs within Optum’s COE networks
  • Develop medical billing code sets for claims-based product analyses. Support product and network colleagues in claims analyses
  • Clinical support in development of new Optum products
  • Clinical support of CSI project managers during product-specific network status qualification processes, i.e., survey development, provider education, and letter writing
  • Clinical support in development and market launch of new Optum products
    

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Bachelor’s Degree in Nursing (BSN) or related field
• Active, unrestricted Registered Nurse (RN) license
• Certification as a medical coder through American Academy of Professional Coders (AAPC) American Health Information Management Association (AHIMA) or willingness to obtain
• 3+ years of experience providing case management services in transplantation, oncology, or cardiology at a managed care organization (MCO) or health insurance company
• 3+ years of experience with researching, developing, and writing medical policies and/or utilization management guidelines
• Medical-surgical clinical experience
• Experience with public speaking including delivering presentations to professional and executive-level audience
• Proficient in Microsoft Word, PowerPoint, and Excel
• Access to install secure, high-speed internet and a dedicated, distraction-free workspace at home

Preferred Qualifications:

• Experience or familiarity with applying the principles of healthcare quality review
• Proven ability to build collaborative relationships with internal and external colleagues
  

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

Colorado, Connecticut, Nevada, or New York City Residents Only: The salary range for Colorado residents is $82,100 to $146,900. The salary range for Connecticut/Nevada/New York City residents is $90,500 to $161,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.