UnitedHealth Group

Lead Clinical Nurse Analyst - San Antonio, TX

UnitedHealth Group$91K — $163K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • Registered or Licensed Vocational Nurse
  • 4+ years of healthcare experience in Claims Processing/Analysis, Medical Billing, Medical Coding, Nursing, or Clinical Operations
  • 3+ years of Clinical Analytics experience
  • 3+ years of process improvement experience
  • 3+ years of advanced experience using Microsoft Office applications, including databases and word processing
  • 3+ years of advanced experience using Visio® and Excel
  • Excellent presentation and communication skills, both oral and written.

Responsibilities

  • Evaluate clinical and medical coding appropriateness of suspecting engines to define improvement needs and escalate to leadership
  • Evaluate clinical actions/suspecting applications to determine appropriate actions
  • Analyze charts and reporting to define system requirements
  • Develop work plans and run test cases to evaluate concurrent tasking
  • Collaborate with team leads to devise business and technical solutions
  • Conduct analyses to determine project feasibility
  • Lead discussions on change requests and organize meetings with stakeholders
  • Collaborate with IT for system migration and support
  • Oversee research and analysis of healthcare data to identify business opportunities
  • Lead user acceptance testing and coordinate system changes
  • Establish relationships with Business and IT Partners to gather requirements
  • Own and document data processes and analytical methodologies
  • Lead process improvements within the team and application processes
  • Perform related duties as assigned.

Benefits

  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase options
  • 401k contribution
  • Development opportunities for career advancement
Full Job Description
The Lead Clinical Analyst will work within the Suspect Services Team focusing on clinical suspecting, Machine Learning, and clinical actions. This position provides clinical and analytical guidance, performs major role in the development and implementation of business needs and oversees the work of Clinical Analysts.

This position follows a hybrid schedule with four in-office days per week.

Primary Responsibilities:

  • Evaluates clinical and medical coding appropriateness of the suspecting engines with the goal of defining improvement needs and escalation to leadership
  • Evaluates clinical actions/suspecting applications and/or systems and selects from a range of alternatives to determine the appropriate action to be taken
  • Analyzes charts, diagrams, and reporting of the problem to be executed and defines system requirements in terms of business and technical capabilities
  • Develops or assists in the development of work plans, task sequencing, and runs test cases to evaluate the extent of how tasks may be performed concurrently
  • Works in tandem with the team leads to devise appropriate business and technical solutions
  • Performs necessary investigations, analyses, and evaluations to determine project feasibility
  • Performs routine duties independently; discusses or seeks approval on complex matters with the director manager
  • Provides status, leads discussion of change requests, and organizes routine and ad-hoc meetings with Suspecting Governance, Working Group Committee and Clinical Actions leaders
  • Works in concert with IT and other technical teams to perform system migration and system support functions
  • Determine and oversee the needed research, interpretation, and analysis of pertinent healthcare data to identify new business opportunities and drive business decisions. (E.g. LOINCs, ICD-10, CPT, etc.)
  • Lead user acceptance testing, coordinate system changes, and system upgrades
  • Establish relationships with Business and IT Partners to lead team with gathering requirements and to ensure business expectations are met
  • Process and documentation owner of data processes, analytical methodologies and dashboard logic to ensure transparency, reproducibility and team alignment
  • Lead process improvements in team and application processes
  • Perform all other related duties as assigned


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:

  • Registered or Licensed Vocational Nurse
  • 4+ years of healthcare experience in one or more of the following areas: Claims Processing/Analysis, Medical Billing, Medical Coding, Nursing, or Clinical Operations.
  • 3+ years of Clinical Analytics experience.
  • 3+ years of process improvement experience.
  • 3+ years of advanced experience using Microsoft office applications, including databases, word-processing.
  • 3+ years of advanced experience using Visio® and Excel
  • Excellent presentation skills with solid communication capabilities and practices, both oral and written.


Preferred Qualifications:

  • Associate or bachelor's degree
  • Certified Professional Coder


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.

About UnitedHealth Group

UnitedHealth Group is a medical facility. They offer health technology, health finance, and pharmacy services. They are utilizing clinical data and intelligence to assist in the redesign, automation, and deployment of technology to streamline administrative operations and clinical decision-making. Payment systems for both consumers and providers are critical components of a health-care system.

UnitedHealth Group Careers

Joining UnitedHealth Group means becoming part of a diverse team dedicated to making a difference. As a leader in health services and innovation, our company offers a variety of job opportunities that allow professionals to leverage their skills, drive innovation, and improve lives. Work You’ll Do At UnitedHealth Group, you’ll contribute to a mission-focused environment where your expertise will influence the health and well-being of people worldwide. Our employment opportunities span across a wide range of disciplines, from healthcare specialists to data analysts, ensuring that your career journey is both dynamic and rewarding. Transform Healthcare with Your Expertise UnitedHealth Group stands at the forefront of health innovation. Our team collaborates to deliver solutions that lead to better patient outcomes. Working with us, you’ll find yourself at the intersection of technology, healthcare, and leadership, providing key insights that drive industry transformation. Join Our Global Team As part of our team, you’ll engage with over 300,000 professionals globally, dedicated to building a diverse and inclusive workplace. UnitedHealth Group is not just a company; it’s a community where you can grow your career through continuous learning and leadership opportunities. Our commitment to diversity training ensures that every team member can thrive. UnitedHealth Group Career Development We are committed to your professional growth. Explore career paths filled with promising job opportunities and internships that will harness your potential and expand your capabilities. Whether you’re a seasoned professional or a recent graduate, you’ll find that our career development programs support your ambition at every level. Innovative Work Environment At UnitedHealth Group, innovation is at the core of our operations. We encourage our team to bring forward-thinking ideas that challenge the status quo and lead to breakthrough improvements in patient care. Be Part of a Great Team Our culture fosters a collaborative and supportive environment where every member’s contribution is valued. Enjoy the benefits of being part of a global team that’s committed to making a difference in people’s lives. Future-Proof Your Career With UnitedHealth Group, your career is future-proof. Dive into a range of positions that offer both challenges and rewards. Our robust support system includes unmatched training, development programs, and certification support to propel your career forward. Stay Connected Join Our Team Discover the right position that matches your skills and interests. We are always hiring and look for passionate, curious, and solution-driven team players. Search UnitedHealth Group jobs today and take the first step towards a fulfilling career. Keep Up to Date Stay informed with career tips, insider perspectives, and industry-leading insights you can use today—all from the people who work here. Read Careers Blog Job Alert Emails Customize your subscription to receive job alerts, the latest news, and insider tips tailored to your preferences. Explore the exciting and rewarding opportunities that await at UnitedHealth Group.
Learn more about UnitedHealth Group
Size
350,000 employees
Market Cap
$493.1 billion
Industry
Net Income
$15.4 billion
Founded
1974
5 Year Trend
+9.2%
Revenue
$257.1 billion
NASDAQ

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