Clinical Consultant - Government Programs - Remote - 2257542

Primary Care Plus; Eden Prairie (MN); Remote; USD 104,000 - 191,000; Full time

Job summary

A leading healthcare organization seeks a Clinical Consultant for Government Programs. This remote role involves identifying customer needs, solving complex problems, and developing strategies to enhance clinical processes. The candidate will work closely with senior leadership and cross-functional teams to ensure compliance and improve health outcomes. Ideal for someone with extensive experience in clinical consulting and regulatory requirements.

Benefits

Comprehensive benefits

Incentives

Stock purchase options

401k contributions

Qualifications

• 5+ years in a clinical consulting role supporting clinical affordability initiatives.
• 4+ years working with Medicare/Medicaid regulatory requirements.

Responsibilities

• Support development of clinical models for complex populations.
• Ensure compliance with governmental payor and contractual requirements.
• Develop and maintain clinical policies and reporting tools.

Skills

Clinical Consulting

Regulatory Compliance

Strategy Development

Communication

Education

Active RN license

Tools

Microsoft Office

Job description

Clinical Consultant - Government Programs - Remote - 2257542

Join to apply for the Clinical Consultant - Government Programs - Remote - 2257542 role at Primary Care Plus.

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. We foster a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Join us to make an impact on the communities we serve as we advance health equity globally. Start Caring. Connecting. Growing together.

Role Overview

The Clinical Consultant for Government Programs will identify potential emerging customer needs and promote innovative solutions. They will solve complex problems impacting the business, develop strategies, support projects, and translate complex concepts for diverse audiences. The role involves influencing senior leadership, leading cross-functional teams, and supporting complex projects to meet key business objectives.

Remote Work Flexibility

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. while tackling challenging projects.

Primary Responsibilities

• Support development of clinical models for complex populations in government programs such as Medicare Advantage and DSNP based on market needs.
• Resolve highly complex business problems affecting clinical processes and requirements.
• Ensure local care delivery complies with all governmental payor, state, federal, NCQA, and contractual requirements through appropriate quality controls.
• Serve as a Clinical SME for internal and external leaders regarding programs like HCBS WAIVER, ABD, TANF/CHIP.
• Promote regulatory compliance and change management across assigned programs.
• Develop and maintain clinical policies, procedures, SOPs, job aids, and reporting tools.
• Prepare leadership reports, program status updates, and compliance documentation upon request.
• Develop executive-level updates and reports.
• Participate in setting measurable business and affordability goals.
• Identify cross-functional improvement opportunities and communication enhancements.

Required Qualifications

• Active RN license.
• 5+ years in a clinical consulting role supporting clinical affordability initiatives in large medical groups or health plans.
• 4+ years working with Medicare/Medicaid regulatory requirements, including Utilization Management, Case Management, or Clinical Product Management.
• Experience with Medicare, Medicaid, and Commercial insurance, including NCQA, URAC, and federal/state regulations.
• Proven ability to develop and execute strategies across large business units or multiple markets.
• Experience with Program Development, Implementation, and Post-Implementation management.
• Advanced proficiency in Microsoft Office applications.
• Willingness to travel up to 50%.
• Adherence to UnitedHealth Group’s Telecommuter Policy for remote employees.

Additional Information

The salary range for residents in California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Maryland, Rhode Island, Washington, D.C. is $104,700 to $190,400 annually, based on various factors. Benefits include comprehensive packages, incentives, stock purchase options, and 401k contributions. The application will be posted for at least 2 business days or until enough candidates are collected. We are committed to diversity, equity, and inclusion, and to providing equitable care to address health disparities.