[Hiring] Senior Clinical Program Manager @UnitedHealth Group

Role Description

As a Senior Clinical Program Manager – Devices and Durable Medical Equipment, you will support and develop programs and initiatives that optimize the utilization and access to medical devices, technology, and equipment in health care. This role supports all lines of business (Medicare, Medicaid, Commercial). The position requires deep knowledge of healthcare devices and durable medical equipment, the evolving market, CPT codes, FDA regulations, and the payment models associated with these technologies. Solid analytical, strategic, and problem-solving skills are required in this role. This is a high-impact opportunity for a self-starter who thrives on driving meaningful change, collaborating across teams, and leading innovative clinical programs. This role will report to the Clinical Director of Health Technology Innovation on the Value Creation team in United Clinical Services.

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

Primary Responsibilities

• Develop device and DME programs that support utilization management in accordance with Medicare and Medicaid guidelines, internal policies, and regulatory requirements.
• Support program ideation and planning in care pathways and value-based initiatives ensuring alignment with regulatory requirements, clinical best practices, and business objectives.
• Serve as a subject matter expert and liaison to address cross-enterprise stakeholder inquiries related to policies and practices of medical device and DME management.
• Proactively identify system and operational issues in the management and deployment of these devices, working with IT and clinical teams to implement sustainable solutions.
• Optimize process flows, claims edit changes, code updates, and triage other operational activities to improve program performance.
• Draft internal and external program communications.
• Collaborate with internal teams, including but not limited to product, program, IT, clinical, payment integrity, legal, regulatory, compliance, networks, and payment policy, among others to facilitate unhindered program operations.
• Identify new opportunities that align with strategic areas of affordability, quality, and access in medical devices and DME.
• Maintain and update categories for existing and emerging DME, devices, and medical technologies, anticipating trends and market needs, and informing health plan policy and operational teams to provide equitable access to high-value devices while reducing utilization of unproven or low-value products and services.
• Explore and evaluate external partners and internal resources to develop innovative care models where devices, equipment, or technology are required including remote and asynchronous care delivery.

Qualifications

• Masters degree: Nursing, Business, Public Health or related field.
• Solid experience with data analysis and interpretation, using insights to improve program operations and inform policy decisions.
• Proven expertise in durable medical equipment and/or medical devices and the associated billing processes and management via health plans.
• Proficiency with MS Office (Excel, Word, PowerPoint, SharePoint).
• Proven ability to manage complex initiatives in a matrixed environment.
• Proven ability to take initiative and drive change - a self-starter who thrives on problem-solving.
• Proven solid communication and presentation skills, including the ability to translate concepts into business and policy strategies.

Preferred Qualifications

• 5+ years of experience in managed care including clinical program management, utilization management, payment integrity, or related experience.
• Advanced proficiency with MS Office (Excel, Word, PowerPoint, SharePoint, Visio, OneNote).
• Proficiency in Smartsheet for tracking and managing operational data.

Travel

• Approximately <5% of time will be spent traveling.

Authority

• Expected to work with minimal direction.
• Responsible for making recommendations such as process improvements, resource allocation, and project prioritization.

Supervisory Responsibility

• No supervisory responsibility.
• Provides guidance, leadership, or training to other employees.

Benefits

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

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

Company Description

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.