Optum ยท 15 hours ago
CCAT Clinical Consultant Mid-Level Practitioner
United States
Full-time
Remote
Mid Level
$92K/yr - $164K/yr
3+ years expOptum is a global organization that delivers care aided by technology to help millions of people live healthier lives. The Mid-Level Practitioner role in the Clinical & Coding Advisory Team (CCAT) involves providing clinical leadership and expertise to improve healthcare operations and outcomes, focusing on fraud prevention and resource development.
EducationHealth CareMedicalPharmaceutical
Responsibilities
Provide expert clinical and strategic leadership for operational teams
Assist with high level clinical reviews (e.g. appeals, peer-to-peer, arbitration, etc.)
Collaborate with clinical operations teams on complex or difficult cases
Apply clinical knowledge in the interpretation of medical policy, clinical resources, and benefit document language in the review of professional and facility pre-pay and post-pay clinical reviews
Collaborate with and educate network and non-network providers on cases and clinical coding situations in pursuit of accurate billing practices
Actively participate in regular meetings and projects focused on clinical decision-making, clinical resources, analytics, savings, and staff training
Other duties and goals assigned by the Sr. Medical Director
Qualification
Required
Current, active, and fully non-restricted licensed Nurse Practitioner (APRN) or Physician Assistant (PA)
3+ years of clinical practice experience
CPT/HCPCS/ICD-9/ICD-10 coding experience with a thorough knowledge of health insurance business, including knowledge of industry terminology and regulatory guidelines
Familiarity with current medical issues and practices
Proven excellent verbal and written communications skills
Proven solid team player and team building skills
Proven solid negotiation and conflict management skills
Solid understanding of Fraud, Waste, Abuse, and Error methodology
Solid problem-solving, negotiation and persuasion skills
Ability to effective lead, manage and deliver in a fast pace, ever changing environment
Ability to foster communications, robust collaboration, and solid partnerships among providers, clients, leaders, and clinical teams
Preferred
Coding Certification through AHIMA (CCS, CDIS, RHIA, RHIT) or AAPC (CIC)
3+ years in facility (DRG and Clinical Validation Audit) reviews
2+ years of experience in leading clinical operations within a health plan/or managed care environment to include client facing experience
Experience with Encoder and Grouper Software (3M)
Knowledge of federal (e.g., CMS) and state laws and regulations
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Benefits
Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Company
Optum
Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group.
10001+ employees
H1B Sponsorship
Optum has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (648)
2024 (559)
2023 (620)
2022 (851)
2021 (593)
2020 (438)
Funding
Current Stage
Late StageLeadership Team
Daniel Castillo
Chief Executive Officer, Optum Care Delivery
J
Jay Green
Chief Financial Officer
Recent News
2025-11-29
2025-11-19
2025-11-07
Company data provided by crunchbase