Senior Healthcare Consultant - Telecommute - Full-time / Part-time

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)

Health Plans face a number of unique environmental pressures that affect the way they will conduct business today and in the future - among them a need for increased privacy and security, an intense focus on risk management, access to capital, efforts to consolidate and streamline IT functions, the launch of new consumer-driven business models, managing chronic diseases through medical management practices, maximizing e-business-driven platforms, implementing health plan-specific customer relationship management tools and complying with increasing financial and transactional legislation. Our healthcare professionals can help clients address these and other challenges in today's complex health care environment.

Our group currently has openings for a variety of skillsets:

First and foremost we are seeking individuals that have worked within a professional consulting organization and/or have worked in a high demand military role.

Health Plan Operations

We are seeking candidates who have consulting experience as it relates to:

• Government Programs - Medicaid, Medicare Advantage, and Medicare Part D


• PBM - Third party administrator of prescription drug programs, pharmacy, administration of claims and benefits, drug utilization, distribution, disease management, and volume purchasing


• Clinical - Payeor disease and utilization management, HIN, ICD10 business processes, technology assessment, planning, remediation and compliance


• Core Admin & Project Management  - Cost containment, process improvement, provider contracting, project management and Health Care Reform


• Product Development - Market assessments and sizing competitive intelligence, sales management and distribution, network development, and vertical integration

Payment Integrity

We are seeking candidates with consulting experience involving Payment Integrity functions such as:

• Claims Editing


• Enrollment Integrity/Coordination of Benefits


• FWA


• Overpayment Identification


• Claims auditing


• Health care Subrogation / Third Party Liability.

Claims Configuration

We are seeking candidates that can lead configuration activities for a core claims administrative system (IKA, QNXT, FACETS, Health Rules, etc) configuration based on expertise in one or more functional areas (e.g., Product, Provider, Member, Finance):

• Lead configuration design activities including direct management of project team members


• Participate in design sessions


• Participate in test development and execution activities


• Provide configuration thought leadership to organization


• Ensure that all configuration documentation is prepared, reviewed, and approved

Qualifications: 

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  Bachelors Degree (BS or BA) and/or Master of Business Administration preferred


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  3+ years working in a Professional Consulting organization


• 
  
  Willingness to travel up to 80% of the time **


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  3+ years Healthcare experience Government Programs, and/or PBM, and/or Clinical Health Management, and/or Core Administer Delivery / Program Management, and/or Product Management, and/or Payment Integrity, and/or Claims System Configuration


• 
  
  Quantitative ability to analyze data


• 
  
  Strong knowledge of Microsoft Office products with a focus on PowerPoint and Excel


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  Strong work ethic and desire to help clients improve their businesses
  

Careers with OptumInsight. 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

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Keywords: healthcare consulting, payment integrity, icd10, system integration, healthedge, configuration analyst