Clinical Consultant - Government Programs - Remote

Lensa; Eden Prairie (MN); Remote; USD 104,000 - 191,000; Full time

Job summary

A leading company is seeking a Clinical Consultant for Government Programs to improve health outcomes through innovative solutions. This remote role requires an active RN license and extensive experience in clinical consulting, particularly with Medicare and Medicaid. The consultant will develop clinical models, ensure compliance, and drive strategic initiatives to enhance care delivery.

Benefits

Comprehensive benefits package

Incentive programs

401k contributions

Equity stock purchase

Qualifications

• 5+ years in clinical consulting supporting affordability initiatives.
• 4+ years with Medicare/Medicaid regulatory requirements.
• Experience in Program Development and Management.

Responsibilities

• Support development of clinical models for governmental programs.
• Resolve complex business problems affecting clinical processes.
• Ensure compliance with governmental payor and contractual requirements.

Skills

Clinical consulting

Regulatory compliance

Cross-functional communication

Strategy formulation

Utilization Management

Case Management

Education

Active RN license

Tools

Microsoft Office

Job description

Clinical Consultant - Government Programs - Remote

1 day ago Be among the first 25 applicants

Lensa is the leading career site for job seekers at every stage of their career. Our client, UnitedHealth Group, is seeking professionals. Apply via Lensa today!

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 diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Clinical Consultant - Government Programs is responsible for identifying potential emerging customer needs and promoting innovative solutions to meet them. They solve unique and complex problems with broad impact on the business. They participate in the development of business strategy and support complex projects to achieve key business objectives. They will translate highly complex concepts in ways that can be understood by a variety of audiences, influence senior leadership to adopt new ideas, products, and/or approaches, and direct cross-functional and/or cross-segment teams.

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

Primary Responsibilities

• Support development of clinical models for complex populations in governmental programs, e.g., Medicare Advantage and DSNP, based on the assigned market.
• Resolve highly complex business problems affecting clinical processes and functional requirements.
• Ensure local care delivery compliance with all governmental payor, state, federal, NCQA, and contractual requirements through implementation/recommendation of appropriate quality controls, checks, and balances.
• Serve as a Clinical SME for external and internal leaders regarding governmental programs, e.g., HCBS WAIVER, ABD, TANF/CHIP.
• Promote regulatory compliance processes and change management on all assigned programs and initiatives.
• Participate in the development and maintenance of clinical policies, procedures, SOPs, job aids, reporting, and assessment tools relevant to clinical value programs.
• Prepare documents and reports for leadership, program status, and compliance updates upon request.
• Develop executive-level updates and reports as needed.
• Contribute to the development of measurable business and affordability goals.
• Identify and recommend cross-functional improvements and opportunities.
• Enhance cross-functional communication processes.

You’ll be rewarded and recognized for your performance in an environment that challenges you and provides clear success criteria and development opportunities.

Required Qualifications

• Active RN license.
• 5+ years of experience in a clinical consulting role supporting clinical affordability initiatives in large medical groups or health plans.
• 4+ years working with Medicare, Medicaid regulatory requirements, with experience in Utilization Management, Case Management, or Clinical Product Management.
• Experience with Medicare, Medicaid, and Commercial insurance, including NCQA, URAC, and federal/state regulatory requirements.
• Experience developing and executing strategies across large business units or multiple markets/sites.
• Experience with Program Development and Management, including strategy formulation, active implementation, and post-implementation management.
• Advanced proficiency in Microsoft Office applications.
• Willingness to travel up to 50%.
• Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.

Note for residents of California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Maryland, Rhode Island, Washington, D.C.: The salary range is $104,700 to $190,400 annually, based on various factors. Benefits include comprehensive packages, incentive programs, equity stock purchase, and 401k contributions. Benefits are subject to eligibility.

Application Deadline: Minimum 2 business days or until a sufficient candidate pool is reached. The posting may close early due to application volume.

Our mission is to help people live healthier lives and improve the health system for everyone. We are committed to equity, diversity, and inclusion, addressing health disparities and promoting health outcomes.