Healthcare Payer Consultant - Telecommute

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

The health care markets are evolving in many different ways and the role and impact of the Medicaid is becoming increasingly important as health plans and providers look for new ways to grow and manage risk. In particular, the ability to manage medical cost through care management interventions or network management strategies is critical to the success of these organizations.

Optum is seeking a Healthcare Payer Consultant to provide Business Analysis expertise in the Government Payor markets. This position is responsible for the business analysis and operations consulting in all areas of Medicare Advantage, ACA and Medicaid products including LTSS, HCBS, Duals Population, Complex Care, Population Health, and provider sponsored organizations taking on risk for some of the most complex populations.

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

Primary Responsibilities:
  • Responsible for gathering and documenting business requirements, solution, design and testing of Claims, Eligibility and/or Care Management Applications
  • Documents and provides recommended business operational workflow
  • Provides subject matter expertise in more than one of the following capabilities: Membership, Provider, Claims, Finance and/or Clinical domains
  • Provide insight to clients around the CMS and state specific regulations, guidelines and policies around waiver programs and requirements
  • Consults and engages with clients to resolve issues and presents options for resolution
  • Define market needs and gaps to current capabilities
  • Engages with other consultants to develop strategies, process and workflow to support the client needs
  • Ensures the requirements and deliverables meet the client needs and provides recommended solutions through business traceability matrices
  • Creates relationships and delivers value to clients and business stakeholders
  • Engages with the Business Solutions Architecture Teams to define application and technical solutions
  • Escalates issues to business partners and leadership
  • Supports program communication plan and execution
  • Ensures quality assurance methods are implemented within programs
  • Provide status updates and review of programs to senior leadership
  • Establish trusted client relationships to expand the Payer Consulting footprint at designated clients
  • Participates in a team-oriented work climate that enables professional development and encourages creative solutions and strategies
  • Participates in Community of Practice leadership forums
  • Ensures utilization rates are attained annually
  • Obtains high client satisfaction scores (>90%)

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:
  • 5+ years of experience working for a Medicare Advantage, ACA or Medicaid Health plan
  • 5+ years of business analysis experience writing business requirements, user stories with traceability and end to end testing
  • 3+ years of experience in a Consulting role
  • 2+ years of documenting standard operating procedures
  • 2+ years of System Analysis experience and creating business area context diagrams
  • Experience in Business Analysis best practices
  • Ability to recommend and implement applications efficiently for small to large payer or provider organizations
  • Ability and willingness to travel 80% of the time
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:
  • Bachelor's degree or equivalent experience
  • Experience with CMS Regulations
  • Experience with SQL
  • Experience with agile methodology and agile applications
  • Ability to develop reports
  • Excellent presentation, writing and negotiation skills

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado Residents Only: The salary/hourly range for Colorado residents is $94,500 to $171,700. 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 Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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 drugfree workplace. Candidates are required to pass a drug test before beginning employment.

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