Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Clinical Quality Consultant for the Oncogenetic Program provides guidance and support for utilization management related to advanced molecular and genetic testing in oncology. This role ensures evidence-based decision-making, compliance with regulatory standards, and optimal patient outcomes through expert interpretation of genomic data and collaboration with multidisciplinary teams. The position requires experience in molecular pathology and oncogenetics, combined with demonstrated collaboration skills and the ability to thrive in a fast-paced, technology-driven environment.

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

Primary Responsibilities:

• Work to improve quality and promote evidence-based medicine
• Ensure the right service is provided at the right time for each member
• Work with medical director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review and provider appeals clinical review

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• PhD degree in molecular pathology, genetics, or similar
• 5+ years of clinical experience in oncology or genetic medicine
• Experience with genomic data interpretation software (e.g., NextGen sequencing analysis tools)
• Knowledge of regulatory and compliance standards (CMS, NCCN, ASCO guidelines) for genetic testing and oncology care
• Familiarity with molecular diagnostic coding systems and claims platforms
• Proficiency in interpreting next-generation sequencing (NGS) and other advanced molecular diagnostic technologies
• Proven ability to work effectively in a fast-paced, technology-driven environment
• Proven ability to review work performed by others and provide recommendations

Preferred Qualifications:

• Hands-on utilization and/or quality management experience
• Experience in using electronic clinical systems
• Proven to serve as a key resource on complex molecular diagnostic cases

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 to $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

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.