Clinical Content Developer - Medicaid - Remote - Remote Eligible

Clinical Content Developer

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Join our team at Optum Insight, where we are leveraging cutting-edge AI and machine learning technologies to revolutionize healthcare delivery, enhance customer engagement, and drive innovation across our digital platforms.

The licensed Clinical Content Developer RN, NP, PA develops and updates the clinical content of Optum Clinical Products. Using critical appraisal and review of medical literature, synthesis of clinical information, and data analysis and with collaboration of external peer reviewers, their role is to ensure the clinical content represents best evidentiary practice standards and will meet requirements for different users, applications, and contexts. The Clinical Content Developer is also responsible for quality assurance (QA) of the content and for responding to internal and external client questions and concerns.

We are looking for a licensed RN, NP, or PA, with a broad clinical background who can join our fully remote team and collaborate with us on the development of quality content for the InterQual suite of products.

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

Primary Responsibilities:

• Utilizing the principles of evidence-based medicine (EBM), design, develop, and update clinical content through the critical appraisal and synthesis of information gathered from extensive review of the medical literature and Medicaid State Policy for InterQual content products. Collect and incorporate feedback from external peer reviewers and clients to ensure real-world clinical accuracy and usability
• Perform Quality Assurance of clinical content and create and maintain clinical documentation, as required
• Serve as a clinical resource and subject matter expert for both internal and external customers
• Leverage AI tools to enhance productivity and innovation by streamlining workflows and automating repetitive tasks. Evaluate emerging trends to drive continuous improvement and strategic innovation.
• Collaborate with Product Development (PD), Product Management (PM), Product Owner (PO), and Business Systems Analyst (BSA) as needed
• Participate in developing project plans, monitoring tasks, and ensuring on-time delivery of clinical development projects
• Participate in field research that contributes to product advancement as needed
• Travel Limited <10%

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:

• Licensed Healthcare professional - RN, NP, PA - with a license in good standing
• 3+ years of experience in direct patient care
• 1+ years of experience writing professionally or summarizing clinical research studies
• Experience in developing content for prior authorization workflows, especially for Medicaid policies
• Understanding of state-specific Medicaid policies and how they intersect with national medical necessity standards, experience in UM/UR specifically for Medicaid LOB
• Demonstrated proficiency with various software applications, including but not limited to MS Word, MS Excel, MS PowerPoint

Preferred Qualifications:

• 5+ years of advanced practice experience in Inpatient or Ambulatory care setting
• 3+ years of experience in a clinical associated environment or a case management role
• Experience with utilization management (UM), case management, or use of evidence-based guidelines such as InterQual/Clinical Decision Support applications or Medicaid State Policies.
• Proven willingness to learn and explore new technologies
• Research and Evidence-Based Medicine (EBM) knowledge or experience
• Proven knowledge of medical coding schemes
• Demonstrates ability to adopt technology or has proficiency with various software applications, including but not limited to MS Office suites, Teams, and proprietary software
• Proven problem-solving and critical thinking skills; ability to step through logical pathways to arrive at results
• Proven solid verbal and written communication skills
• Proven results-oriented, effective as both a team member and independent worker with attention to detail and ability to multi-task

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 $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.