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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.As the senior level consultant, this position leads cross-functional initiatives aimed at improving clinical practice performance, optimizing data-driven strategies, and supporting care delivery innovation. This role blends clinical engagement with analytical rigor to enhance outcomes for patients, providers, and health system partners. This position will provide expertise and insight into risk capabilities for Optum Health employed group providers.You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:
Lead the end-to-end risk adjustment strategy and execution, including data capture, gap closure, and CMS submission processes, ensuring accuracy, compliance, and alignment with enterprise goals
Oversee the deployment and optimization of point-of-care tools within Epic, partnering with clinical and technical stakeholders to improve risk coding, documentation, and user adoption
Collaborate cross-functionally with operations, analytics, IT, and care delivery teams to translate regulatory requirements and complex business needs into actionable system enhancements
Gather, analyze, and document business requirements for new features, enhancements, and workflow changes, ensuring they are aligned with enterprise strategy and operational needs
Standardize and streamline documentation workflows within Epic to drive accurate coding, complete capture of chronic conditions, and improved care outcomes
Leverage data insights from risk adjustment analytics and Epic reporting to identify coding opportunities, performance gaps, and operational improvements
Guide change management and training efforts related to POC tool deployment, clinical workflow modifications, and new risk adjustment initiatives across markets and provider networks
Ensure ongoing quality assurance and data validation, including user acceptance testing (UAT) and continuous system evaluation to maintain integrity and compliance
Interpret and apply evolving CMS regulations, synthesizing policy changes into system configurations, provider guidance, and business strategy
Act as a liaison between business and technical teams, ensuring Epic configurations and POC tools meet clinical, regulatory, and operational performance needs
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:
10+ years of experience with business requirement/workflow documentation, technical solutions/product management, and data analysis
3+ years of experience with one or more risk adjustment models (e.g. CMS HCC, CDPS, HHS HCC) including documentation requirements, submission requirements and model details
Experience with electronic health record (EHR) systems
Knowledge of Centers for Medicare and Medicaid Services regulations
Demonstrated ability to communicate effectively and problem solve/troubleshoot with both business and technical audiences at all levels of the organization
Demonstrated ability to manage assigned work with minimal oversight
Proven detail oriented analytic thinker
Willing or ability to work 8-5pm EST hours
Preferred Qualification:
Experience with Epic EMR
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyPay 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 $110,200 to $188,800 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.UnitedHealth Group 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.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
