Clinical Program Consultant - Process Modernization - Remote

Position: Clinical Program Consultant - Process Modernization - Remote in US

At United Healthcare, 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 in making healthcare work better for everyone through people-led, responsible AI while Caring.

Connecting. Growing together.

The Clinical Program Consultant - Process Modernization will manage complex workflow modernization and operational improvement initiatives across UCS Operations & Implementation. This role leads assigned projects from discovery and requirements development through solution design, implementation readiness, deployment, and post-launch stabilization. The consultant will partner across clinical, operations, policy, benefits, coding, configuration, product, technology, regulatory, compliance, and line-of-business teams to improve fragmented and manual processes, strengthen standardization and traceability, and enable measurable, scalable workflows.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Lead assigned workflow improvement and modernization initiatives from discovery through implementation, stabilization, and transition to operational ownership
• Develop and maintain integrated project plans covering scope, milestones, deliverables, owners, dependencies, decisions, risks, testing, and implementation activities
• Facilitate workflow discovery with business and clinical stakeholders to identify pain points, manual steps, duplicate activities, fragmented handoffs, control gaps, and improvement opportunities
• Translate workflow findings and strategic priorities into clear requirements, future-state processes, decision points, exception paths, executable workplans, and measurable outcomes
• Coordinate cross-functional delivery across clinical, operations, policy, benefits, coding, configuration, technology, regulatory, compliance, and line-of-business partners
• Establish project cadence, working sessions, status reporting, RAID management, decision tracking, and escalation processes; proactively address critical-path issues affecting scope, schedule, or readiness
• Coordinate requirements validation, testing, change readiness, communications, implementation planning, and post-launch issue resolution
• Provide concise leadership reporting on project progress, milestones, risks, dependencies, decisions, readiness, and outcomes
• Support modernization efforts involving prior authorization intake and configuration, claims edit configuration, manual workflow digitization, DTQ review automation, clinical coding automation, clinical pre-determination, and competitor policy monitoring

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

• Experience facilitating cross-functional discovery or working sessions and translating complex operational needs into clear requirements, decisions, and executable workplans
• Demonstrated experience managing complex projects or programs within healthcare, clinical operations, technology, business operations, or another highly matrixed environment
• Demonstrated experience developing project plans and managing milestones, dependencies, risks, issues, decisions, implementation readiness, and executive status reporting
• Demonstrated proficiency using AI tools to support project delivery, workflow analysis, requirements development, documentation, and business-process improvement
• Demonstrated ability to coordinate clinical, operational, business, and technical stakeholders where accountability and decision-making are distributed
• Demonstrated solid analytical, problem-solving, written, and verbal communication skills
• Demonstrated ability to manage multiple interconnected initiatives and competing priorities

Preferred Qualifications

• PMP, CAPM, Lean, Six Sigma, or comparable project or process-improvement training
• 5+ years of experience in project management, program management, workflow improvement, operational transformation, or a related field
• Healthcare payer or managed-care experience
• Experience supporting prior authorization, clinical review, medical policy, coding,…