Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)
This position works collaboratively with the Director, Risk Adjustment Innovation, Vice President, Risk Adjustment Support and SVP, Risk Adjustment to interpret business strategy and to research, analyze, design and suggest innovative solutions. The focus area is to produce innovative solutions driven by exploratory data analysis from structured and unstructured, diverse datasets. Applies knowledge of statistics, machine learning, programming, data modeling, simulation and advanced mathematics to recognize patters, identify opportunities, pose business questions and make valuable discoveries leading to prototype development and product improvement. The aim of innovation is to challenge the status quo by using process- and technology-based solutions that are transformative in nature. This includes identifying and exploiting opportunities to evolve established processes and systems.
Works collaboratively with WellMed/OptumCare senior leadership to develop an innovation pipeline that allows the Risk Adjustment leadership team to groom, develop and choose inventive ideas to execute. Coordinates all cross-functional activities. Represents Risk Adjustment and collaborates with leaders in various areas to achieve capital allocation when appropriate and implement approved innovative initiatives. This role is responsible for ensuring that Risk Adjustment Business innovation is in alignment with the vision of the organization and Centers for Medicare and Medicaid Services (CMS) requirements.
Reports to the Director, Risk Adjustment Business Innovation
Primary Responsibilities:

• Applies knowledge of statistics, machine learning, programming, data modeling, simulation and advanced mathematics to recognize patters, identify opportunities, pose business questions and make valuable discoveries leading to prototype development and product improvement
• The focus area is to produce innovative solutions driven by exploratory data analysis from structured and unstructured, diverse datasets
• Solves unique and complex problems within the Medicare Risk Adjustment business model with broad impact on the business and patient care
• Develops an innovation pipeline with transformative activities that include both application logic and processes. The innovation pipeline should lend itself to a one-to-five-year road map
• Collaborates with senior leadership to ensure activities are appropriately integrated into the strategic direction, as well as the mission and values of the company
• Responsible for ensuring DataRAP innovation is in alignment with the vision of the organization and CMS requirements
• Provides leadership for project teams and coordinates activities to execute on innovation items
• Seeks ways to improve business processes and operational efficiency that are transformative (not incremental) and makes suggestions as appropriate.
• Develops the annual budgets necessary for innovation pipeline items for their assigned department and implements plans to achieve budgetary goals
• Collaborates with technology teams in developing technical solutions that will result in accurate and efficient data collection, data management and data reconciliation related to risk adjustment factor data processing (within the scope of the innovation pipeline).
• Liaisons with Finance, Operations, Network Management, Compliance, Claims/Encounters, IT, Legal and other related departments as required advancing approved innovation items.
• Performs 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:

• Bachelor's degree in Healthcare Administration, Business Administration, Information Technology, Technology or a related field (10 additional years of experience may be substituted in lieu of degree)
• 5+ years of experience in Medicare Risk Adjustment and/or HEDIS Quality
• Knowledge of ICD-10 coding requirements and regulations
• Proven track record in managing major projects and/or programs
• Intermediate-level competence with Microsoft Office applications
• Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Prefered Qualifications:

• Experience in effectively reporting data, analyzing facts and exercising sound judgment when making recommendations to members of the Senior Leadership Team
• Ability to work with all levels of the organization and major departments to accomplish defined objectives

Physical & Mental Requirements:

• Ability to sit/stand for extended periods of time
• Ability to travel periodically
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to properly drive and operate a company vehicle
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
Job Keywords: Principal Data Scientist, Risk Adjustment, Risk Management, Datasets, Claims Adjuster, CMS, Texas, TX, San Antonio