**Healthcare Consultant Payer Consulting- Multiple Locations - Telecommuter - Travel

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.

Optum Payer Consulting currently has openings for a variety of consulting skillsets within our Operational Excellence Practice Area:  First and foremost we are seeking individuals that have worked within a professional consulting organization and/or have worked within a professional consulting organization, that have a strong desire to focus on Health plan operations and who enjoy onsite client consulting interaction.   Our Healthcare Consultants spend 80-85% of their time working on Health plan operational projects and delivering those improvement solutions. 

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 - Payer 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

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



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  2+ years working in a Professional Consulting organization



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



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  2+ 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



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  Strong knowledge of operational readiness and/or, and/or impact analysis, and/or benchmark analysis and/or healthcare exchanges



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  Quantitative ability to analyze data



• Lean/Six Sigma background preferred


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  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