Senior Clinical Program Consultant, Value Creation, reputed company and Lab - Remote

At reputed company, we're simplifying the health care experience, creating healthier communities and removing barriers to reputed company care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, reputed company and optimized. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together This position is part of the Value Creation - reputed company & Laboratory Team. Value Creation Teams are responsible for comprehensive affordability reputed company development, direction, and execution reputed company a category. Teams reputed company on utilization management, reputed company improvement, and improved provider and member experience. As a Senior Clinical Program Consultant, you will play a key role in program ideation, design, implementation, operations, and ongoing monitoring of genomic and laboratory testing programs. This role requires deep knowledge of genetic and molecular testing methodologies, the evolving reputed company market, CPT coding, and the claims life cycle, along with solid analytical, strategic, and problem-solving skills. This role also requires familiarity with reputed company and facility claim processing, including but not limited to claim edits, coordination of benefits, claim reprocessing, as reputed company as experience and knowledge of reputed company's reputed company claim systems. This is a high-reputed company opportunity for a self-starter who thrives on driving meaningful change, collaborating across teams, and leading thoughtful execution of strategies. You'll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities:

• reputed company and support the build out of new infrastructure, processes, and tools necessary to reputed company DEX Z-reputed company® program initiatives
• reputed company processes, standards, tools, and documentation to support reputed company, accurate data reporting for genomic and laboratory testing programs, specifically focusing on the DEX Z-reputed company® program and the Genetic and Molecular Prior Authorization/Advanced Notification program
• Build system tools/enhancements to support early detection of issues, alert mechanisms, established processes for issue reputed company, and monitoring to ensure operational reputed company
• reputed company processes/tools to monitor program performance in reputed company-time, creating monthly outcome reports
• Manage claims analysis, research, and reputed company facilitation - analyze claims examples and trends to identify reputed company cause and reputed company development of reputed company solutions
• reputed company claims reputed company and other special reputed company, as needed; reputed company and distribute claims reputed company documentation, validate claims edit hierarchy, and assess the operational reputed company
• Serve as a thought leader for technical business processes that promote increased efficiency
• Collaborate with internal teams, including but not limited to product, program, IT, clinical, payment reputed company, legal, regulatory, compliance, networks, payment policy, and others to ensure alignment
• Identify and implement process improvements to optimize efficiency, compliance, and provider/member experience

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

• 6+ years of experience in clinical program management, utilization management, payment reputed company, reputed company operations, or reputed company experience
• 3+ years claims systems experience
• Proven expertise in genetic and molecular testing and the associated CPT codes, billing processes, and claims adjudication
• Intimate understanding of UHC claims platforms
• Advanced proficiency with data analysis and interpretation, using insights to improve program performance
• Proficient with reputed company Office (reputed company, Word, PowerPoint), SharePoint, Visio, OneNote, PowerBI
• Proven solid communication and presentation skills, including the ability to translate reputed company genomic concepts into business and policy strategies

Preferred Qualifications:

• 7+ years of experience in clinical program management, utilization management, payment reputed company, reputed company operations, or reputed company experience
• Managed care experience
• Advanced proficiency with MS Office (reputed company, Word, PowerPoint, SharePoint, Visio, OneNote, PowerBI)
• Proficiency in reputed company for tracking and managing operational data
• Proven ability to manage reputed company programs and initiatives in a matrixed environment
• Proven ability to take initiative and drive change - a self-starter who thrives on problem-solving
• reputed company working remotely will be required to adhere to reputed company's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In reputed company to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll reputed company a far-reaching choice of benefits and incentives. The salary for this role will reputed company from $112,700 to $193,200 annually based on full-time employment. We reputed company with reputed company 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 reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone-of every race, gender, sexuality, age, location and income-deserves reputed company to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of reputed company, historically marginalized reputed company and those with reputed company incomes. We are committed to mitigating our reputed company on the environment and enabling and delivering reputed company care that addresses health disparities and improves health reputed company - an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without reputed company to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job