Sr. Clinical Program Consultant, Risk & Quality - West Region Remote

Optum; Albuquerque (NM); Remote; USD 113,000 - 193,000; Full time

Job summary

Optum, part of UnitedHealth Group, seeks a Sr. Clinical Program Consultant, Risk & Quality for the West Region Remote. You will drive risk adjustment and quality initiatives with data-driven strategies, improving coding accuracy and HEDIS/STARS results.

You will collaborate with senior clinical, coding, and operational leaders to standardize approaches and deliver measurable financial and quality improvements while working remotely across the United States.

Qualifications

• 4+ years of experience with value-based care programs within a managed care environment.
• Experience designing standardized operational frameworks, workflows, and governance structures to support scalable programs.
• Demonstrated ability to analyze and synthesize clinical, coding, financial, and/or operational data to identify performance gaps and develop targeted improvement strategies.
• Experience leading cross-functional teams and influencing stakeholders across analytics, operations, clinical, coding, compliance, and executive leadership functions.

Responsibilities

• Lead enterprise-wide risk adjustment and quality programs across the West Region with significant clinical and financial impact.
• Design and implement standardized program frameworks and operating models to improve coding accuracy and quality outcomes.
• Drive care gap closure performance (HEDIS/STARS) and population-level clinical outcomes through data-driven strategy.
• Drive documentation improvement initiatives in partnership with coding and provider teams.
• Oversee quality performance programs, ensuring alignment with regulatory requirements and performance targets.
• Translate complex data (clinical, coding, financial, value-based) into actionable strategies and executive insights.
• Lead cross-functional collaboration across coding, analytics, clinical, and operational teams.
• Identify performance gaps and implement targeted, scalable interventions.
• Partner with senior leadership, market teams, analytics, and provider organizations to ensure alignment and execution at scale.

Skills

Value-based care

Cross-functional leadership

Data analysis

Stakeholder communication

Healthcare analytics

Provider engagement

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Sr. Clinical Program Consultant, Risk & Quality - West Region Remote (2385403)

Sr. Clinical Program Consultant, Risk & Quality - West Region Remote - 2385403

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

The Senior Clinical Program Consultant – Risk & Quality is responsible for leading the design and execution of risk adjustment and quality improvement initiatives across the West Region. This role acts as a regional leader accelerator and force multiplier - driving accurate clinical documentation, and HEDIS/STARS performance through scalable, data-driven programs.

This position partners with senior clinical, coding, and operational leaders to standardize approaches, enhance provider performance, and deliver measurable improvements in financial and quality outcomes.

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

Primary Responsibilities:

• Lead enterprise-wide risk adjustment and quality programs across the West Region with significant clinical and financial impact
• Design and implement standardized program frameworks and operating models to improve coding accuracy and quality outcomes
• Drive care gap closure performance (HEDIS/STARS) and population-level clinical outcomes through data-driven strategy
• Drive documentation improvement initiatives in partnership with coding and provider teams
• Oversee quality performance programs, ensuring alignment with regulatory requirements and performance targets
• Translate complex data (clinical, coding, financial, value-based) into actionable strategies and executive insights
• Lead cross-functional collaboration across coding, analytics, clinical, and operational teams
• Identify performance gaps and implement targeted, scalable interventions
• Partner with senior leadership, market teams, analytics, and provider organizations to ensure alignment and execution at scale

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:

• 4+ years of experience with value-based care programs within a managed care environment
• Demonstrated experience developing and implementing enterprise or multi-market program strategies that improved risk score accuracy, quality performance, or other value-based outcomes
• Proven experience designing standardized operational frameworks, workflows, and governance structures to support scalable programs
• Demonstrated ability to analyze and synthesize clinical, coding, financial, and/or operational data to identify performance gaps and develop targeted improvement strategies
• Experience leading cross-functional teams and influencing stakeholders across teams such as analytics, operations, clinical, coding, compliance, and executive leadership functions

Proven track record of implementing corrective action plans and performance improvement initiatives that resulted in measurable gains in quality metrics, risk adjustment performance, value-based performance, or operational effectiveness

Preferred Qualifications:

• PMP or program management certification
• CPC, CRC, CCS, RHIA, RHIT, CPHQ, or other relevant healthcare quality/coding certification
• 1+ years of experience with Risk Management and Quality Programs
• Experience partnering with providers, clinical leaders, and coding teams to improve clinical documentation, diagnosis capture, coding accuracy, and chart audit outcomes
• Experience supporting Medicare Advantage STARS improvement initiatives and health plan risk adjustment programs
• Experience leading large-scale transformation initiatives involving quality improvement, value-based care, population health, or provider performance management programs
• Advanced proficiency with healthcare analytics and reporting tools used to evaluate quality, coding, and risk adjustment performance
• Experience with CMS guidelines, audits, and compliance frameworks
• Risk adjustment and quality expertise
• Strategic leadership program leadership
• Data analysis and performance optimization
• Provider engagement and influence
• Cross-functional coordination
• Innovation and continuous improvement
• Regulatory and compliance awareness

*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 $112,700 to $193,200 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 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.

OptumCare is 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.

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

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

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.