Clinical Programs Manager - Eden Prairie, MN - Full-time / Part-time

Reporting to the Director of Clinical Programs, the Clinical Program Manager is part of a team responsible for achieving over $800 million dollars in annual savings for UHC Fully Insured and ASO along with increasing IOI for Optum through a combination of existing program expansion and new program ideation. This role is responsible for the identification/triage of new medical cost savings opportunities independently and through collaboration with UHG business partners, program/project management and executing on select initiatives. 

Primary Responsibilities:

• Managing a portfolio of projects.


• Providing clinical and coding expertise to FWAE Operations


• Collaborating with matrix partners and stakeholders across UHG in development of new and expanded audit programs- Including AAL, UHC PI, UCS, Legal, Finance, and OptumHealth


• Triaging the initiative pipeline to ensure focus on highest yielding opportunities


• Meeting FWAE savings targets


• Providing input on existing and new UHC medical and drug policies


• Consulting with Medical Directors and other clinical resources when necessary


• Preparing project/program level reports by collecting, analyzing, and summarizing data and trends

• Registered Nurse with a non-restricted license


• 4+ years of broad clinical experience


• 2+ years of project/program management experience


• Previous managed care or provider billing experience


• Proficiency with Microsoft Word, Excel, and PowerPoint


• Strong communication and presentation skills; able to present effectively to all levels of leadership


• Knowledge of Fraud/Waste/Abuse principles


• Ability to function independently and effectively in a self-directed environment


• Ability to understand and influence the necessary and appropriate actions to ensure program/project success; a bias for action is critical


• Proven ability to operate in a highly dynamic environment

Preferred Qualifications:

• Extensive coding knowledge and/or Coding Certification


• Working knowledge of CMS and state Medicaid regulations

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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)