Clinical Consultant Sr, Risk Adjustment Enablement

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.

Position Summary

The Clinical Consultant Sr, Risk Adjustment Enablement, serves in a high-impact support role across two strategic domains: Risk Adjustment Infrastructure Enablement and Risk Adjustment Clinical Operations Enablement. This role is designed to provide clinical and operational support to the Risk Adjustment Infrastructure Enablement and the Risk Adjustment Clinical Ops Enablement, contributing to the execution of scalable, compliant, and clinically sound risk adjustment strategies. The consultant collaborates across coding, benefit design, vendor strategy, and home/community-based care models to ensure alignment with enterprise goals.

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

Primary Responsibilities:

• Support for Risk Adjustment Infrastructure Enablement
  • Support the development of benefit design proposals by translating clinical insights into actionable recommendations
  • Assist in the clinical review and validation of standardized code sets (CPT, LOINC, ICD, HCPCS, SNOMED CT, RxNorm) for reporting and billing
  • Collaborate with finance and quality teams to ensure incentive models align with evidence-based care
  • Participate in vendor evaluation and performance monitoring in partnership with enablement teams
• Support for Risk Adjustment Clinical Operations Enablement
  • Assist in aligning clinical and operational workflows across OH Regional CDOs to support scalable risk adjustment performance
  • Contribute to the execution of home and community-based enablement strategies (OAH, FPM, HC) across OH businesses (excluding SCC)
  • Provide clinical input into documentation standards and workflow optimization
• Cross-Functional Collaboration
  • Work closely with coding, analytics, clinical operations, and vendor teams to ensure clinical relevance and operational feasibility
  • Translate clinical guidance into actionable support for infrastructure and operations teams

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:

• Licensed Nurse Practitioner or Physican Assistant with clinical experience in risk adjustment, documentation, or home/community-based care

• Experience/exposure collaborating with cross-functional teams including clinical, technical, and operational stakeholders

• Solid understanding of Medicare Advantage, HCC models, and coding systems
• Proven excellent communication and organizational skills

*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 $91,700 to $163,700 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.