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Healthcare Payer Consultant - Eden Prairie, MN or Telecommute

Eden Prairie, MN

Date posted:

Apr 8, 2021

No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. The rewards for performance are significant. You'll help improve the health of millions. And you'll do your life's best work.(sm)

The health care markets are evolving in many different ways and the role and impact of the Medicaid is becoming increasingly important as health plans and providers look for new ways to grow and manage risk. In particular, the ability to manage medical cost through care management interventions or network management strategies is critical to the success of these organizations.

Optum is seeking a Healthcare Payer Consultant to provide Business Analysis expertise in the Government Payor markets. This position is responsible for the business analysis and operations consulting in all areas of Medicare Advantage, ACA and Medicaid products including LTSS, HCBS, Duals Population, Complex Care, Population Health, and provider sponsored organizations taking on risk for some of the most complex populations.

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

Primary Responsibilities:

Responsible for gathering and documenting business requirements, solution, design and testing of Claims, Eligibility and/or Care Management Applications

Documents and provides recommended business operational workflow

Provides subject matter expertise in more than one of the following capabilities: Membership, Provider, Claims, Finance and/or Clinical domains

Provide insight to clients around the CMS and state specific regulations, guidelines and policies around waiver programs and requirements

Consults and engages with clients to resolve issues and presents options for resolution

Define market needs and gaps to current capabilities

Engages with other consultants to develop strategies, process and workflow to support the client needs

Ensures the requirements and deliverables meet the client needs and provides recommended solutions through business traceability matrices

Creates relationships and delivers value to clients and business stakeholders

Engages with the Business Solutions Architecture Teams to define application and technical solutions

Escalates issues to business partners and leadership

Supports program communication plan and execution

Ensures quality assurance methods are implemented within programs

Provide status updates and review of programs to senior leadership

Establish trusted client relationships to expand the Payer Consulting footprint at designated clients

Participates in a team oriented work climate that enables professional development and encourages creative solutions and strategies

Participates in Community of Practice leadership forums

Ensures utilization rates are attained annually

Obtains high client satisfaction scores (>90%)

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

5 + years experience working for a Medicare Advantage, ACA or Medicaid Healthplan

5 + years of business analysis experience writing business requirements, user stories with traceability and end to end testing

3 + years' experience in a Consulting role

2 + years documenting standard operating procedures

2 + years System Analysis experience and creating business area context diagrams

Experienced in Business Analysis best practices

Ability to recommend and implement applications efficiently for small to large payer or provider organizations

80% Travel required

If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications :

Bachelor's degree or equivalent experience

CMS Regulations

SQL experience

Ability to develop reports

Excellent presentation, writing and negotiation skills

Experience with agile methodology and agile applications

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy

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.

Job Keywords: Medicaid, healthcare, consulting, payer, management, consultant, telecommute, telecommuter, telecommuting, remote, work from home, Optum Consulting

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