Clinical Program Consultant - Process Modernization - Remote in US

UnitedHealthcare; Minnetonka (MN); Remote; USD 92,000 - 131,000; Full time

Job summary

UnitedHealthcare is seeking a Clinical Program Consultant - Process Modernization to lead workflow modernization and operational improvement initiatives across UCS Operations & Implementation. You will partner with clinical, operations, policy, benefits, coding, configuration, product, technology, regulatory, compliance, and line-of-business teams to improve processes and enable scalable workflows.

You’ll enjoy the flexibility to work remotely from anywhere in the U.S.

Qualifications

• Experience facilitating cross-functional discovery sessions and translating needs into clear requirements.
• Experience managing complex projects or programs within healthcare, clinical operations, technology, or matrixed environments.
• Experience developing project plans and managing milestones, dependencies, risks, issues and governance.
• Proficiency using AI tools to support project delivery, workflow analysis, and process improvement.
• Ability to coordinate clinical, operational, business, and technical stakeholders.
• Strong analytical, problem-solving, written, and verbal communication skills.
• Ability to manage multiple interconnected initiatives and competing priorities.

Responsibilities

• Lead workflow modernization initiatives from discovery to deployment and ownership.
• Develop integrated project plans covering scope, milestones, owners, risks, testing and activities.
• Facilitate workflow discovery with stakeholders to identify pain points and opportunities.
• Translate findings into clear requirements, future-state processes and measurable outcomes.
• Coordinate cross-functional delivery across clinical, operations, policy, benefits, coding, configuration, technology, regulatory and line-of-business partners.
• Establish cadence, sessions, RAID management, decision tracking and escalation processes.
• Coordinate requirements validation, testing, change readiness, communications and implementation planning.
• Provide leadership reporting on progress, milestones, risks, dependencies and readiness.
• Support modernization efforts including prior authorization intake and automation initiatives.

Skills

Cross-functional collaboration

Project management

AI tooling

Requirements development

Stakeholder coordination

Analytical skills

Tools

AI tools

Job description

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 in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

The Clinical Program Consultant - Process Modernization will manage complex workflow modernization and operational improvement initiatives across UCS Operations & Implementation. This role leads assigned projects from discovery and requirements development through solution design, implementation readiness, deployment, and post-launch stabilization. The consultant will partner across clinical, operations, policy, benefits, coding, configuration, product, technology, regulatory, compliance, and line-of-business teams to improve fragmented and manual processes, strengthen standardization and traceability, and enable measurable, scalable workflows.

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

Primary Responsibilities

• Lead assigned workflow improvement and modernization initiatives from discovery through implementation, stabilization, and transition to operational ownership
• Develop and maintain integrated project plans covering scope, milestones, deliverables, owners, dependencies, decisions, risks, testing, and implementation activities
• Facilitate workflow discovery with business and clinical stakeholders to identify pain points, manual steps, duplicate activities, fragmented handoffs, control gaps, and improvement opportunities
• Translate workflow findings and strategic priorities into clear requirements, future-state processes, decision points, exception paths, executable workplans, and measurable outcomes
• Coordinate cross-functional delivery across clinical, operations, policy, benefits, coding, configuration, technology, regulatory, compliance, and line-of-business partners
• Establish project cadence, working sessions, status reporting, RAID management, decision tracking, and escalation processes; proactively address critical-path issues affecting scope, schedule, or readiness
• Coordinate requirements validation, testing, change readiness, communications, implementation planning, and post-launch issue resolution
• Provide concise leadership reporting on project progress, milestones, risks, dependencies, decisions, readiness, and outcomes
• Support modernization efforts involving prior authorization intake and configuration, claims edit configuration, manual workflow digitization, DTQ review automation, clinical coding automation, clinical pre-determination, and competitor policy monitoring

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

• Experience facilitating cross-functional discovery or working sessions and translating complex operational needs into clear requirements, decisions, and executable workplans
• Demonstrated experience managing complex projects or programs within healthcare, clinical operations, technology, business operations, or another highly matrixed environment
• Demonstrated experience developing project plans and managing milestones, dependencies, risks, issues, decisions, implementation readiness, and executive status reporting
• Demonstrated proficiency using AI tools to support project delivery, workflow analysis, requirements development, documentation, and business-process improvement
• Demonstrated ability to coordinate clinical, operational, business, and technical stakeholders where accountability and decision-making are distributed
• Demonstrated solid analytical, problem-solving, written, and verbal communication skills
• Demonstrated ability to manage multiple interconnected initiatives and competing priorities

Preferred Qualifications

• PMP, CAPM, Lean, Six Sigma, or comparable project or process-improvement training
• 5+ years of experience in project management, program management, workflow improvement, operational transformation, or a related field
• Healthcare payer or managed-care experience
• Experience supporting prior authorization, clinical review, medical policy, coding, claims, benefits, or healthcare configuration processes
• Experience with workflow redesign, process improvement, automation, digitization, or technology-enabled transformation
• Experience managing projects from discovery and requirements through testing, deployment, and stabilization
• All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $130,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.