Clinical Program Consultant - Genomics and Laboratory - Remote

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

This position is part of the Value Creation - Genomics & Laboratory Team. Value Creation Teams are responsible for comprehensive affordability strategy development, direction, and execution within a category. Teams focus on cost, utilization management, quality improvement, revenue maximization, and improved provider and member experience. The Clinical Program Consultant supports clinical programs within the Genomics & Laboratory category.

As a Clinical Program Consultant - Genomics and Laboratory, you will play a key role in program ideation, design, implementation, operations, and ongoing monitoring of genomic and laboratory testing programs. This role requires deep knowledge of genetic and molecular testing methodologies, the evolving genomics market, CPT coding, and the claims life cycle, along with strong analytical, strategic, and problem-solving skills. This is a high-impact opportunity for a self-starter who thrives on driving meaningful change, collaborating across teams, and leading innovative clinical programs.

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

Primary Responsibilities:

• Support Genomics and Laboratory Clinical Program Management and Operations
• Support end-to-end program operations ensuring they align with regulatory requirements, clinical best practices, and business objectives
• Address provider, member, and network inquiries related to program operations such as genetic test registration, prior authorization submissions, and claims submissions
• Proactively identify system and operational issues, working with IT and clinical teams to implement sustainable solutions
• Optimize project plans, process flows, and cost-benefit analyses to improve program performance
• Collaborate with internal teams, including but not limited to product, program, medical policy, IT, clinical, payment integrity, special investigations unit, legal, regulatory, compliance, networks, reimbursement policy to ensure smooth program operations
• Support program monitoring and reporting using key performance metrics.
• Identify opportunities for enhancement to existing clinical programs that align with strategic areas of affordability, quality, and access in genomic and laboratory testing
• Leverage Deep Knowledge in Genetic and Laboratory Testing and Claims Life Cycle
• Serve as a subject matter expert (SME) in genetic and molecular laboratory testing methodologies, 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

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:

• Bachelor's degree in genetics, molecular biology, public health, healthcare administration, or related field
• 5+ years of experience in managed care including clinical program management, utilization management, medical policy, payment integrity, or related experience
• 1+ years claims systems/reimbursement methodologies experience
• Solid experience with data analysis and interpretation, using insights to improve program operations and inform policy decisions
• Proficiency with MS Office (Excel, Word, PowerPoint, SharePoint)
• Proven expertise in genetic and molecular testing methodologies and their associated CPT codes, billing processes, and claims adjudication
• 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
• Proven ability to take initiative and drive change-a self-starter who thrives on problem-solving

Preferred Qualification:

• Project management experience, including leading cross-functional teams and implementing new programs

Travel

• Approximately <5% of time will be spent traveling

Authority

• Expected to work with minimal direction
• Responsible for making recommendations such as process improvements, resource allocation, and project prioritization

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The salary range for this role is $89,800 to $176,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

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.

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