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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


Job Category:

Business Operations



Approximate Salary:

Not Specified

Position Type:

Full Time

Risk Adjustment Data and Operations Manager - Ontario, CA

UHG - Ontario, California

Posted: 12/10/2018


If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)


Position Summary

We are seeking a Risk Adjustment Data and Operations Manager for our Ontario, CA location. Responsible for focusing and assessing the health of group plans of Medicare members through data analysis and tracking; identify and solve problems connected with the Eligibility/Claims and other departments; collect and organize information from a variety of sources and analyze how data can impact the various Medicare and CMS systems; focusing on product, service or process decisions that are most likely to impact multiple groups of employees and/or customers, internal or external; resolving problems and providing guidance to members of the team; adapting departmental plans and priorities to address business and operational challenges; influencing or providing input to forecast and plan activities.  She will use statistical analysis, simulations, predictive modeling, or other methods to analyze information and develop practical solutions for our Medicare members and advise managers and other decision makers on the effects of various courses of action to take to improve our services to our members. This supervises 2 analysts, coordinators or managers.


  • Master's degree or equivalent in Business Administration, Engineering, Computer Science, or Mathematics or related technical or quantitative field and related experience.
  • 5 years related progressive, post-baccalaureate experience.
  • Must also have 3 years demonstrated ability with each of the following: 1) Various CMS risk adjustment models and in operationalizing those models in a business setting; 2) Business process re-engineering and implementation of information technology systems in clinical and provider settings; 3) BI platforms and data analytics methods; 4) SDLC life cycles and implementing EMR systems, lab systems and pharmacy systems; and 5) Interoperability between healthcare systems. Employer will accept experience gained concurrently. Will accept experience gained before, during or after Master's program.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)



Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.


UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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