UnitedHealth Group Healthcare Economic Consultant - Santa Ana, CA in Santa Ana, California

Some people take things as they come. Others relentlessly push themselves to go farther. Combine health care and technology, which are two of the fastest-growing fields on the planet, with UnitedHealth Group's culture of performance, collaboration and opportunity and this is what you get: industry-leading health care services at a company that's improving the lives of millions.

As the Health Care Economics Consultant you will design and develop reports and analyze data to measure clinical outcomes, network performance and methodology levers. You will investigate key business problems through quantitative analyses of utilization and health care costs data. As the Consultant, you will interpret and analyze clinical data from various sources and recommend best approaches for its consolidation. Your analyses will be used to create viable, real-world solutions in a complex health care landscape. The work is as challenging as it is rewarding. You'll open doors to new opportunities. This is where bold people with big ideas are writing the next chapter in health care. Join us. There's never been a better time to do your life's best work. (sm)

If you are located in Santa Ana, CA , you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Analyze member information to ensure the Risk Adjustment Factor accurately reflects the member health profile, financial and clinical information

  • Prepare and review integrated analysis and reports to ensure the accuracy and completeness of the Medicare Risk Adjustment data, and to ensure compliance with all CMS regulations and guidelines

  • Identifies trends and patterns within the Risk Adjustment data and medical record coding to segment and identify areas of risk and opportunity for additional medical record review, member and provider intervention

  • Provide management with analysis based on an understanding of the financial impacts of decisions pertaining to Medicare Risk Adjustment and revenue

  • Assist in development of membership revenue projections, forecast and budget based on member risk adjustment score and monitoring of variances to identify trends

  • Assist in preparation and implement of necessary internal controls for related entities consistent with CMS and to support RADV or other regulatory audits

Required Qualifications:

  • Bachelor of Science/Arts Degree in accounting, finance, economics, computer sciences or related field

  • 2+ years of managed care or healthcare experience

  • Knowledge of SQL, SAS or other relational database software

Preferred Qualifications:

  • Experience analyzing health risk scores

  • 2+ years of experience in medical coding or risk adjustment

  • Knowledge of Medicare/CMS

  • Knowledge of ICD-9/ICD-10 and CPT codes

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work. SM

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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

Job Kywords: Healthcare Economics, Consultant, Santa Ana, CA, California