Senior Consultant Business Systems

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

We are seeking a highly skilled and experienced Senior Consultant Business Systems with a specialization in Utilization Management within the Healthcare sector. The ideal candidate will have over 8 years of experience in business systems consulting, demonstrating an extensive track record of successful project delivery and management. This role involves working closely with healthcare organizations to optimize their utilization management processes, ensuring efficient and effective use of resources to enhance patient care and operational performance.

Primary Responsibilities:

• Consulting and Analysis: Provide expert consulting services to healthcare organizations, conducting thorough analyses of their current utilization management systems, identifying areas for improvement, and recommending practical solutions
• Project Management: Lead and manage large-scale projects from inception to completion, ensuring that project goals, timelines, budgets, and deliverables are met
• System Implementation: Oversee the implementation of new business systems and the integration of utilization management tools, working closely with IT teams and stakeholders to ensure seamless deployment
• Stakeholder Engagement: Build and maintain solid relationships with key stakeholders, including healthcare providers, administrators, and IT professionals, to align project objectives with organizational goals
• Training and Support: Develop and deliver comprehensive training programs for healthcare staff on new systems and processes, providing ongoing support and troubleshooting as needed
• Regulatory Compliance: Ensure that all utilization management practices comply with relevant healthcare regulations and standards, including HIPAA and other governing bodies
• Data Analysis and Reporting: Utilize data analytics to monitor and evaluate the performance of utilization management systems, generating detailed reports and insights to drive continuous improvement
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Bachelor’s degree in Business Administration, Healthcare Management, Information Systems, or a related field. A Master’s degree or relevant certifications (e.g., PMP, Six Sigma) are highly desirable
• 8+ years of experience in business systems consulting, with a solid focus on utilization management within the healthcare sector
• Proficiency in healthcare information systems, data analytics tools, project management software, basic database operations, basic UML diagram creation, and process optimization. Familiarity with electronic health records (EHR) systems and utilization management software is essential
• Problem-Solving: Demonstrated ability to identify complex problems, analyze options, and implement effective solutions in a fast-paced healthcare environment
• Communication: Proven excellent verbal and written communication skills, with the ability to present complex information clearly to diverse audiences
• Leadership: Proven leadership and team management skills, with the ability to inspire and guide multidisciplinary teams to achieve project success
• Adaptability: Proven ability to adapt to changing healthcare landscapes and evolving utilization management practices, staying current with industry trends and advancements

Preferred Qualifications:

• Certifications: PMP, Six Sigma, or other relevant project management or process improvement certifications
• Advanced Analytics: Experience with advanced data analytics, machine learning, and predictive modeling to enhance utilization management practices
• Healthcare Regulations: In-depth knowledge of healthcare regulations, including HIPAA, and experience ensuring compliance in all aspects of utilization management
• Change Management: Expertise in change management methodologies to facilitate smooth transitions and adoption of new systems and processes
• Client Relationship Management: Proven solid client relationship management skills, with the ability to build trust and rapport with healthcare providers and administrators

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.