[Hiring] Senior Clinical Program Consultant @UnitedHealth Group

Role Description

The Senior Clinical Program Consultant – Risk & Quality is responsible for leading the design and execution of risk adjustment and quality improvement initiatives across the West Region. This role acts as a regional leader accelerator and force multiplier - driving accurate clinical documentation, and HEDIS/STARS performance through scalable, data-driven programs.

This position partners with senior clinical, coding, and operational leaders to standardize approaches, enhance provider performance, and deliver measurable improvements in financial and quality outcomes.

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

Primary Responsibilities:

• Lead enterprise-wide risk adjustment and quality programs across the West Region with significant clinical and financial impact.
• Design and implement standardized program frameworks and operating models to improve coding accuracy and quality outcomes.
• Drive care gap closure performance (HEDIS/STARS) and population-level clinical outcomes through data-driven strategy.
• Drive documentation improvement initiatives in partnership with coding and provider teams.
• Oversee quality performance programs, ensuring alignment with regulatory requirements and performance targets.
• Translate complex data (clinical, coding, financial, value-based) into actionable strategies and executive insights.
• Lead cross-functional collaboration across coding, analytics, clinical, and operational teams.
• Identify performance gaps and implement targeted, scalable interventions.
• Partner with senior leadership, market teams, analytics, and provider organizations to ensure alignment and execution at scale.

Qualifications

• 4+ years of experience with value-based care programs within a managed care environment.
• Demonstrated experience developing and implementing enterprise or multi-market program strategies that improved risk score accuracy, quality performance, or other value-based outcomes.
• Proven experience designing standardized operational frameworks, workflows, and governance structures to support scalable programs.
• Demonstrated ability to analyze and synthesize clinical, coding, financial, and/or operational data to identify performance gaps and develop targeted improvement strategies.
• Experience leading cross-functional teams and influencing stakeholders across teams such as analytics, operations, clinical, coding, compliance, and executive leadership functions.
• Proven track record of implementing corrective action plans and performance improvement initiatives that resulted in measurable gains in quality metrics, risk adjustment performance, value-based performance, or operational effectiveness.

Requirements

• PMP or program management certification.
• CPC, CRC, CCS, RHIA, RHIT, CPHQ, or other relevant healthcare quality/coding certification.
• 1+ years of experience with Risk Management and Quality Programs.
• Experience partnering with providers, clinical leaders, and coding teams to improve clinical documentation, diagnosis capture, coding accuracy, and chart audit outcomes.
• Experience supporting Medicare Advantage STARS improvement initiatives and health plan risk adjustment programs.
• Experience leading large-scale transformation initiatives involving quality improvement, value-based care, population health, or provider performance management programs.
• Advanced proficiency with healthcare analytics and reporting tools used to evaluate quality, coding, and risk adjustment performance.
• Experience with CMS guidelines, audits, and compliance frameworks.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).