UnitedHealthcare · 14 hours ago
Clinical Program Consultant, Genomics and Laboratory - Remote
United States
Full-time
Remote
Mid, Senior Level
$92K/yr - $164K/yr
5+ years expUnitedHealthcare is committed to simplifying the health care experience and improving community health. The Clinical Program Consultant will play a key role in implementing and managing genomic and laboratory testing programs, focusing on operational excellence and collaboration across various teams.
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Responsibilities
Support genomics and laboratory clinical program operations, focusing primarily on the DEX Z-Code® program
Support end-to-end program operations ensuring they align with regulatory requirements, clinical best practices, and business objectives
Address provider, member, and internal stakeholder inquiries related to program operations such as DEX Z-Code registration, quarterly code updates, business rule updates, and claims submissions
Proactively identify system and operational issues, working with IT and clinical teams to implement sustainable solutions
Optimize process flows, claims edit changes, code updates, and triage other operational activities to improve program performance
Draft internal and external program communications
Collaborate with internal teams, including but not limited to product, program, IT, clinical, payment integrity, legal, regulatory, compliance, networks, and payment policy, among others to facilitate unhindered program operations
Identify opportunities for enhancement to existing clinical programs that align with strategic areas of affordability, quality, and access in genomic and laboratory testing
Serve as a subject matter expert (SME) in genetic and molecular laboratory CPT coding and claims processing life cycle across multiple lines of business and across multiple internal teams
Maintain and update utilization management categories for CPT codes specific to genomic and laboratory testing
Qualification
Required
5+ years of experience in clinical program management, utilization management, payment integrity, healthcare operations or related experience
1+ years of claims systems/reimbursement methodologies experience
Solid experience with data analysis and interpretation, using insights to improve program operations and inform policy decisions
Proven expertise in genetic and molecular testing and the associated CPT codes, billing processes, and claims adjudication
Proficiency with Microsoft Office (Excel, Word, PowerPoint)
Proven ability to manage complex programs and initiatives in a matrixed environment
Proven solid communication and presentation skills, including the ability to translate complex genomic concepts into business and policy strategies
Preferred
7+ years of experience in clinical program management, utilization management, payment integrity, healthcare operations, or related experience
Managed care experience
Advanced proficiency with Microsoft Office (Excel, Word, PowerPoint, SharePoint, Visio, OneNote)
Proficiency in Smartsheet for tracking and managing operational data
Proven ability to take initiative and drive change-a self-starter who thrives on problem-solving
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
UnitedHealthcare
UnitedHealthcare helps people live healthier lives by simplifying the health care experience.
10001+ employees
H1B Sponsorship
UnitedHealthcare 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 (48)
2024 (26)
2023 (45)
2022 (61)
2021 (60)
2020 (68)
Funding
Current Stage
Late StageLeadership Team
Beth Soberg
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Bobby Gregoire
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