Sr. Healthcare Consultant, Physician Medicare and Analytics - Remote

Requisition Number: 2391017
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 in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.
As part of Optum Health's Healthcare Economics Network Strategy & Analytics Department, this role is responsible for producing high-quality analytical deliverables while helping to drive the development of standardized reporting, scalable analytic processes, and data management practices that support organizational goals. Successful candidates will demonstrate strong communication skills, intellectual curiosity, initiative, and the ability to adapt and contribute effectively in a dynamic, collaborative environment.
This role primarily supports CMS Physician repricing activity in SAS and creates dashboards in Tableau and PowerBI used by contractors for local markets. This role also validates provider and payor network contracting and trend management activities through financial or pricing modeling, negotiation support, analysis, and reporting. The team and this role manage reimbursement benchmarking, performance reporting, maintenance of associated financial models, and other responsibilities as assigned.
This role will partner closely with contracting, finance, actuarial, operations, provider relations, and executive leadership teams to evaluate pricing impacts, support provider negotiations, and drive data-informed business decisions.
Positions in this function research and investigate key business problems through quantitative analyses of utilization and healthcare costs data. Provides management with statistical findings and conclusions. Identifies potential areas for medical cost improvements and alternative pricing strategies. Provides data in support of actuarial, financial and utilization analyses.

• Reviews the work of others
• Develops innovative approaches
• Sought out as expert
• Serves as a leader/ mentor

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Primary Responsibilities:

• Analyze large healthcare datasets using SAS and monitor cost, utilization, reimbursement, and market trends to identify risks and opportunities
• Develop and maintain interactive Tableau and Power BI dashboards using repricing outputs to support network strategy, contracting initiatives, and business decision-making
• Ensure pricing, reimbursement, and reporting methodologies are accurate, consistent, statistically sound, and transparent
• Analyze provider reimbursement analysis, pricing model development, and financial impact assessments to support network strategy and contract negotiations
• Design and implement sound tools utilizing programming languages, BI tools (Tableau, PowerBI), and other resources to identify principal health care cost and revenue drivers, by market segment and/or by provider/payor, referral patterns, and reimbursement rates
• Involved with the development of SQL queries, analytical models, dashboards, and automated reporting tools to support executive decision-making
• Support initiatives focused on cost containment, network optimization, and operational performance improvement in collaboration with cross-functional stakeholders
• Present analytical findings and strategic recommendations to leadership and build strong partnerships across contracting, finance, actuarial, and market teams
• Standardize and document repeatable processes to promote best practices and scalability.

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:

• Undergraduate degree or equivalent experience
• 3+ years of experience in healthcare finance, network analytics, and performing analysis on large sets of facility and professional claim data for a payer/health plan or provider/care delivery system.
• 3+ years of experience working with methodology of FFS, Shared Risk and Savings models, Accountable Care activities including opportunity identification and communication.
• Experience working with healthcare claims and reimbursement methodologies
• Advanced proficiency working with query, business intelligence and statistical tools, include SAS, SQL, Tableau, and Power BI
• Advanced proficiency in Microsoft Excel, including pivot tables, formulas, and financial modeling
• Knowledge of Provider payment methodologies including:
  • Risk Continuum Model - Fee-for-service, Capitation, Value-based and incentive payment models
  • Medicare, Commercial and Medicaid-based reimbursement
• Proven solid attention to detail and ability to manage multiple priorities
• Proven solid analytical and quantitative problem-solving skills
• Proven effective written and verbal communication skills
• Proven ability to work collaboratively across cross-functional teams

Required Qualifications:

• Bachelor's degree in finance, Healthcare Administration, Economics, Statistics, Mathematics, Business Analytics, or related fields
• Experience in managed care, health insurance, PPO networks, or provider contracting environments
• Experience with claims systems, contract modeling software, or reimbursement configuration platforms
• Knowledge of CMS reimbursement methodologies and regulatory guidelines
• Familiarity with actuarial or healthcare financial analysis concepts

*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 - $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 help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.
UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.