Value Creation Senior Clinical Program Manager - Devices and Durable Medical Equipment - Remote
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
As a Senior Clinical Program Manager – Devices and Durable Medical Equipment, you will support and develop programs and initiatives that optimize the utilization and access to medical devices, technology, and equipment in health care. This role supports all lines of business (Medicare, Medicaid, Commercial). The position requires deep knowledge of healthcare devices and durable medical equipment, the evolving market, CPT codes, FDA regulations, and the payment models associated with these technologies. Solid analytical, strategic, and problem-solving skills are required in this role. This is a high-impact opportunity for a self-starter who thrives on driving meaningful change, collaborating across teams, and leading innovative clinical programs. This role will report to the Clinical Director of Health Technology Innovation on the Value Creation team in United Clinical Services.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Develop device and DME programs that support utilization management in accordance with Medicare and Medicaid guidelines, internal policies, and regulatory requirements
Support program ideation and planning in care pathways and value based initiatives ensuring alignment with regulatory requirements, clinical best practices, and business objectives
Serve as a subject matter expert and liaison to address cross enterprise stakeholder inquiries related to policies and practices of medical device and DME management
Proactively identify system and operational issues in the management and deployment of these devices, working with IT and clinical teams to implement sustainable solutions
Optimize process flows, claims edit changes, code updates, and triage other operational activities to improve program performance
Draft internal and external program communications
Collaborate with internal teams, including but not limited to product, program, IT, clinical, payment integrity, legal, regulatory, compliance, networks, and payment policy, among others to facilitate unhindered program operations
Identify new opportunities that align with strategic areas of affordability, quality, and access in medical devices and DME
Maintain and update categories for existing and emerging DME, devices, and medical technologies, anticipating trends and market needs, and informing health plan policy and operational teams to provide equitable access to high value devices while reducing utilization of unproven or low value products and services
Explore and evaluate external partners and internal resources to develop innovative care models where devices, equipment, or technology are required including remote and asynchronous care delivery
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:
Masters degree: Nursing, Business, Public Health or related field
Solid experience with data analysis and interpretation, using insights to improve program operations and inform policy decisions
Proven expertise in durable medical equipment and/or medical devices and the associated billing processes and management via health plans
Proficiency with MS Office (Excel, Word, PowerPoint, SharePoint)
Proven ability to manage complex initiatives in a matrixed environment
Proven ability to take initiative and drive change-a self-starter who thrives on problem-solving
Proven solid communication and presentation skills, including the ability to translate concepts into business and policy strategies
Preferred Qualifications
5+ years of experience in managed care including clinical program management, utilization management, payment integrity, or related experience
Advanced proficiency with MS Office (Excel, Word, PowerPoint, SharePoint, Visio, OneNote)
Proficiency in Smartsheet for tracking and managing operational data
Travel
Approximately Apply To This Job
As a Senior Clinical Program Manager – Devices and Durable Medical Equipment, you will support and develop programs and initiatives that optimize the utilization and access to medical devices, technology, and equipment in health care. This role supports all lines of business (Medicare, Medicaid, Commercial). The position requires deep knowledge of healthcare devices and durable medical equipment, the evolving market, CPT codes, FDA regulations, and the payment models associated with these technologies. Solid analytical, strategic, and problem-solving skills are required in this role. This is a high-impact opportunity for a self-starter who thrives on driving meaningful change, collaborating across teams, and leading innovative clinical programs. This role will report to the Clinical Director of Health Technology Innovation on the Value Creation team in United Clinical Services.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Develop device and DME programs that support utilization management in accordance with Medicare and Medicaid guidelines, internal policies, and regulatory requirements
Support program ideation and planning in care pathways and value based initiatives ensuring alignment with regulatory requirements, clinical best practices, and business objectives
Serve as a subject matter expert and liaison to address cross enterprise stakeholder inquiries related to policies and practices of medical device and DME management
Proactively identify system and operational issues in the management and deployment of these devices, working with IT and clinical teams to implement sustainable solutions
Optimize process flows, claims edit changes, code updates, and triage other operational activities to improve program performance
Draft internal and external program communications
Collaborate with internal teams, including but not limited to product, program, IT, clinical, payment integrity, legal, regulatory, compliance, networks, and payment policy, among others to facilitate unhindered program operations
Identify new opportunities that align with strategic areas of affordability, quality, and access in medical devices and DME
Maintain and update categories for existing and emerging DME, devices, and medical technologies, anticipating trends and market needs, and informing health plan policy and operational teams to provide equitable access to high value devices while reducing utilization of unproven or low value products and services
Explore and evaluate external partners and internal resources to develop innovative care models where devices, equipment, or technology are required including remote and asynchronous care delivery
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:
Masters degree: Nursing, Business, Public Health or related field
Solid experience with data analysis and interpretation, using insights to improve program operations and inform policy decisions
Proven expertise in durable medical equipment and/or medical devices and the associated billing processes and management via health plans
Proficiency with MS Office (Excel, Word, PowerPoint, SharePoint)
Proven ability to manage complex initiatives in a matrixed environment
Proven ability to take initiative and drive change-a self-starter who thrives on problem-solving
Proven solid communication and presentation skills, including the ability to translate concepts into business and policy strategies
Preferred Qualifications
5+ years of experience in managed care including clinical program management, utilization management, payment integrity, or related experience
Advanced proficiency with MS Office (Excel, Word, PowerPoint, SharePoint, Visio, OneNote)
Proficiency in Smartsheet for tracking and managing operational data
Travel
Approximately Apply To This Job