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Job Details

UnitedHealth Group

Clinical Program Consultant - Remote




O Fallon, Missouri, United States

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

The Clinical Prog Consultant, Supplemental Data Management & Audit Support is responsible for participating in and creating the data mapping documents for the audit and management of supplemental data sources (SDS) including source verification & documentation for audit, data validation, data provisioning oversight and HEDIS® audit support, as well as consultative service related to supplemental data for the Enterprise Clinical Data & Interoperability (ECDI) organization. The team member will collaborate with the Single Data Repository (SDR) team, OCG team, Quality, Optimization & Insights (QOI) and other appropriate areas of the business, to ensure the most efficient management of data for the greatest Enterprise gain. All work of this team supports Commercial, Medicare & Medicaid quality improvement programs.

Depending on the specific role and business line, example responsibilities in this function could include creating specifications to bring data into a common structure, creating product specifications and models, developing data solutions to support analyses, performing analysis, interpreting results, developing actionable insights, and presenting recommendations for use across the company. Roles in this function could partner with stakeholders to understand data requirements and develop tools and models such as segmentation, dashboards, data visualizations, decision aids and business case analysis to support the organization. Other roles involved could include producing and managing the delivery of activity and value analytics to external stakeholders and clients. Team members will typically use business intelligence, data visualization, query, analytic and statistical software to build solutions, perform analysis and interpret data.

Additionally, this role will support process improvement through the identification, verification, and documentation of data source management processes, as well as development of associated action plans.

The position can telecommute however work hours are either Central or Eastern Time zones.

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

Primary Responsibilities:

  • Stay current with current NCQA HEDIS® Technical Specifications with each annual update
  • Consultative resource for measures and reporting requirements for HEDIS® (per technical specifications) across the enterprise (all lines of business, clinical & operational business units)
  • Create a data mapping document for the Audit submission. Also, able to check the existing DTL mapping and update the mapping document if needed
  • Track work plan associated with maintaining and obtaining supplemental data mapping details, managing auditor requirements and associated documentation
  • Manage audit documentation completion and delivery to Quality & Value Solutions Delivery
  • Maintain and communicate metrics pertaining to supplemental data source management
  • Support the Audit Support team through HEDIS® season activities (see Source Management, Data Management, Audit Management)
  • Works independently; seeks guidance on only the most complex tasks
  • Works collaboratively with Quality Solutions Delivery, SDR and PEDS teams

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:

  • Undergraduate degree or equivalent work experience
  • 3+ years of experience in the Healthcare Industry
  • 3+ years of experience within IT and/or as a Business Analyst
  • 2+ years of experience with NCQA HEDIS
  • 2+ years of experience with data gathering and analysis

Preferred Qualifications:

  • 2+ years of experience writing SQL queries
  • Advanced MS Excel and MS Access skills and an advanced proficiency with MS Office (Including Word, Outlook, PowerPoint, Visio)
  • Ability to manage multiple projects at a time

Technology Careers with Optum. Information and technology have amazing power to transform the health care industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life's best work.(sm)

Colorado, Connecticut, Nevada, or New York City Residents Only: The salary range for Colorado residents is $82,100 to $146,900. The salary range for Connecticut/Nevada/New York City residents is $90,500 to $161,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

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


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.