Optum ยท 20 hours ago
Clinical Consultant Sr, Risk Adjustment Enablement
United States
Full-time
Remote
Senior Level
$92K/yr - $164K/yrOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The Clinical Consultant Sr, Risk Adjustment Enablement provides clinical and operational support across Risk Adjustment Infrastructure and Clinical Operations Enablement, collaborating with various teams to ensure effective risk adjustment strategies.
EducationHealth CareMedicalPharmaceutical
Responsibilities
Support for Risk Adjustment Infrastructure Enablement
Support the development of benefit design proposals by translating clinical insights into actionable recommendations
Assist in the clinical review and validation of standardized code sets (CPT, LOINC, ICD, HCPCS, SNOMED CT, RxNorm) for reporting and billing
Collaborate with finance and quality teams to ensure incentive models align with evidence-based care
Participate in vendor evaluation and performance monitoring in partnership with enablement teams
Support for Risk Adjustment Clinical Operations Enablement
Assist in aligning clinical and operational workflows across OH Regional CDOs to support scalable risk adjustment performance
Contribute to the execution of home and community-based enablement strategies (OAH, FPM, HC) across OH businesses (excluding SCC)
Provide clinical input into documentation standards and workflow optimization
Cross-Functional Collaboration
Work closely with coding, analytics, clinical operations, and vendor teams to ensure clinical relevance and operational feasibility
Translate clinical guidance into actionable support for infrastructure and operations teams
Qualification
Required
Licensed Nurse Practitioner or Physician Assistant with clinical experience in risk adjustment, documentation, or home/community-based care
Experience/exposure collaborating with cross-functional teams including clinical, technical, and operational stakeholders
Solid understanding of Medicare Advantage, HCC models, and coding systems
Proven excellent communication and organizational skills
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Benefits
A 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.
Founded in 2011
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