Optum Insight is looking to revolutionize healthcare delivery, enhance customer engagement, and drive innovation across its digital platforms by leveraging cutting-edge AI and machine learning technologies. The licensed Clinical Content Developer RN, NP, PA will develop and update the clinical content of Optum Clinical Products, ensuring it represents best evidentiary practice standards and meets requirements for different users, applications, and contexts.
Requirements
- Licensed Healthcare professional - RN, NP, PA - with a license in good standing
- 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
- Experience with utilization management (UM), case management, or use of evidence-based guidelines such as InterQual/Clinical Decision Support applications or Medicaid State Policies.
- Demonstrates ability to adopt technology or has proficiency with various software applications, including but not limited to MS Office suites, Teams, and proprietary software
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
Other
- 3+ years of experience in direct patient care
- Travel Limited <10%
- Proven willingness to learn and explore new technologies
- Research and Evidence-Based Medicine (EBM) knowledge or experience
- Proven problem-solving and critical thinking skills; ability to step through logical pathways to arrive at results
