US Clinical Consultant
About the job
- At least 3 years of clinical nursing experience in the U.S. healthcare system.
- Knowledge of Microsoft Office.
- Knowledge of medical terminology and U.S. healthcare processes.
- Proficiency in creating PowerPoint presentations and Excel documents.
- Effective verbal and written communication skills.
- Solid clinical acumen and awareness of the U.S. healthcare system.
- Ability to deliver instructor-led, face-to-face, or virtual training.
- Ability to prioritize multiple tasks and monitor them through completion.
- Organizational skills and multitasking abilities.
- Technical aptitude and proficiency with analytical and decision-making skills.
- Capability in digital content creation, curriculum design, and Microsoft Office 365 applications and tools.
- Ability to provide clear directions and set specific expectations.
- Collaborate with Solutioning and Transitions on new business needs, including demonstrations, staff profiles, training content, and timelines.
- Assess learning needs of individuals and teams within clinical business processes.
- Develop learning goals, objectives, curriculum, and measurements that promote desired performance outcomes.
- Create and deliver complex clinical foundation content using adult learning principles and strategies while considering business needs.
- Use learning technologies and tools for presentation, collaboration, and engagement.
- Facilitate and manage learning in web-based and face-to-face environments.
- Review evaluative data to make improvements or establish new initiatives and business improvement solutions.
- Update curriculum and assessments based on changes and relevant feedback.
- Establish working relationships with staff and management at all levels.
- Provide coaching, guidance, and feedback to learners.
- Monitor new lines of business until they reach steady state and conduct transition support.
- Provide clinical refresher and upskilling training for lines of business as needed.
- Conduct clinical acumen assessments during hiring and provide attrition review support as needed for non-RN-led teams.
- Anticipate customer needs and develop solutions to meet them.
- Serve as a key resource on complex or critical issues.
- Perform complex conceptual analyses, solve complex problems, and develop innovative solutions.
- Review others’ work and recommend improvements.
- Assess and interpret clinical education needs and requirements across businesses.
- Coordinate with others to develop program or process implementation plans.
- Communicate and collaborate with operations managers and business partners to improve production quality and efficiency, develop best practices, and identify clinical process issues.
- Explain difficult issues and provide information to others.
- Identify skill, knowledge, and certification requirements for program or process implementation based on requirements.
- Use a quality-driven approach to identify root causes and process improvement opportunities.
- Communicate and collaborate with key stakeholders regarding findings and recommendations.
- Develop an understanding of clinical and clinical support business needs through process walkthroughs, audit findings, survey results, case reviews, and additional research.
- Perform, assist with, or oversee clinical quality audits.
- Coach, provide feedback, and guide others.
- Provide subject matter expertise to train others on clinical foundation topics.
- Support implementation of business strategies.
- Develop talent at all levels through education, training, and coaching to establish a strong talent pipeline.
- Work with the Business Operations Manager to coordinate new-hire training and ensure clinical foundation training timelines are met.
- Develop program and process tools and resources based on communication and education requirements.
- Identify technology needs to support programs and processes.
- Obtain stakeholder input and feedback during communication development.
- Communicate educational progress and training program status to stakeholders.
- Comply with the employment contract, company policies and procedures, and directives, including possible transfers or reassignments to different work locations, teams, or shifts and changes to work arrangements.
- MCG or InterQual training or certification.
- Certification in Case Management or Managed Care.
- At least 1 year of clinical business process outsourcing experience in inpatient clinical support, Case Management, or Utilization Management.
- At least 1 year of experience training or educating Registered Nurses.
- Ability to work independently and take initiative with strong self-management skills.
- Ability to remain calm under pressure and manage emotional responses during adversity, conflict, and change.
- Interpersonal and communication skills, including communicating with large teams.
- Listening, verbal, and written communication skills.
About the company
UnitedHealth Group runs health insurance and clinical care services for individuals, employers and government programs through UnitedHealthcare and Optum. UnitedHealthcare sells medical benefits for working people, retirees and people covered by public programs, including Medicare and Medicaid. Optum operates medical practices, manages prescription drug benefits and builds software that helps healthcare organizations handle clinical and administrative work. The group earns revenue from insurance premiums, care contracts, pharmacy products and service fees. UnitedHealth Group was incorporated in 1977 and is headquartered in Eden Prairie, Minnesota.
Company Size
10,001+
Company Stage
IPO
Headquarters
Eden Prairie, Minnesota
Founded
1977
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Simplify's Take
What believers are saying
- UnitedHealth generates cash for reinvestment: July 2026 results reported $11.1 billion in second-quarter operating cash flow.
- Career paths span care and technology: UnitedHealth lists clinical, data, business operations and support career areas.
- Optum Insight diversifies buyers: its software services target health plans, providers, governments and life sciences companies.
What critics are saying
- UnitedHealth restructuring affects jobs: January 2026 results disclosed $746 million for late-2025 workforce cuts and property consolidation.
- Optum carries unprofitable contracts: January 2026 results disclosed $623 million reserved for relationships it cannot exit during 2026.
- UnitedHealthcare absorbs care-cost increases: insurance premiums typically stay fixed per person for a year.
What makes UnitedHealth Group unique
- UnitedHealth connects care spending to finance: Optum Financial runs health accounts and payments to medical providers.
- UnitedHealth combines technology with clinical scale: its 2025 workforce included nearly 165,000 clinical professionals.
- Optum Rx promises predictable drug spending: Clear Trend Guarantee combines pharmacy cost guarantees into one per-member price.
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Benefits
Flexible Work Hours
Growth & Insights and Company News
6 month growth
-8%1 year growth
-8%2 year growth
-8%US stock futures were mixed on Tuesday as investors weighed a wave of earnings reports. Dow futures rose 0.9%, S&P 500 futures slipped 0.1%, and Nasdaq futures fell 0.7%. Memory stocks fell for a second day after a Chinese chipmaker, CXMT, said it had made a breakthrough in memory chip production. Roundhill Memory ETF fell more than 5% in premarket trading. UnitedHealth rose more than 2% after it earned an adjusted $4.69 per share on $112.69 billion in revenue, beating estimates. It raised its full-year earnings outlook to at least $20.50 per share. Goldman Sachs gained more than 3% on strong results. JPMorgan Chase, Wells Fargo, and Citigroup fell short in parts of their reports. Johnson & Johnson fell 2% after $25.40 billion in sales narrowly missed estimates, though it raised its full-year forecasts.
Texas launches UnitedHealth Group investigation over denials. Texas Attorney General Ken Paxton has opened a UnitedHealth Group investigation into allegations that the company used deceptive and unlawful practices that denied Texans medically necessary care, according to his office's Oct. 5 announcement. The office said it has issued Civil Investigative Demands to the company. The probe adds state-level legal exposure for the country's largest health insurer at a time when it is replacing several senior executives. For providers, the inquiry centers on issues they deal with directly: coverage decisions, authorization practices and the role of insurers in care decisions. [TABLE OF CONTENTS] What the UnitedHealth Group investigation covers. Paxton's office said the demands seek evidence of potential violations of the Texas Deceptive Trade Practices Act and other state laws. The investigation follows reports about how the company administers health benefits and makes coverage decisions, according to the announcement. Among the allegations the office cited are reports that the company gave nursing homes financial incentives to avoid or delay transferring patients to hospitals. The office is also examining whether the company's practices could amount to the unlawful corporate practice of medicine, KLBJ-AM in Austin reported. "Alarming reports keep piling up about how United treats Texas consumers," Paxton said in a statement. Paxton is also a Republican candidate for U.S. Senate. The allegations have not been proven, and the investigation does not establish that the company violated the law. UnitedHealth told Austin television station KXAN it did not have a response to share. Related Texas probe and pending litigation. The inquiry is the second Paxton has announced against a major insurer in recent weeks. His office earlier opened an investigation into Blue Cross Blue Shield of Texas and its parent, Health Care Service Corp., over procedures for denying and delaying urgent and medically necessary care and over prior authorization requirements, according to the attorney general's news releases. UnitedHealthcare also faces new private litigation. A proposed class action filed Sept. 30 in U.S. District Court for the District of Connecticut alleges the insurer's copay accumulator policy unlawfully stopped crediting drug manufacturer assistance toward a member's deductible and out-of-pocket limit, according to the complaint. Leadership changes at the insurer. The investigation arrives after a series of executive moves at the company in September, most of them announced by the executives on LinkedIn: * Bobby Hunter, previously CEO of government programs at UnitedHealthcare, became president of UnitedHealthcare, he said Sept. 28. * Dan Kueter, who led UnitedHealthcare's commercial business, became chief commercial officer of UnitedHealth Group. * Brandon Cuevas returned from Kaiser Permanente after three years to become CEO of UnitedHealthcare's commercial business, he said Sept. 22. * Jodee Kozlak was named the company's first chief administrative officer, effective Sept. 28, according to published reports. Hunter wrote that he will focus on accelerating the insurer's "modernization agenda" to make health care more connected and easier to navigate. Tim Noel remains CEO of UnitedHealthcare, the company told Reuters, according to Healthcare Brew. The appointments draw largely on company veterans. Hunter joined UnitedHealth Group in 2011 and held a series of Medicare roles before leading government programs, according to published reports. Cuevas spent 14 years at UnitedHealthcare before leaving for Kaiser Permanente, where he was executive vice president for its national health plan. Kueter wrote on LinkedIn that his new role involves working across UnitedHealthcare and Optum to coordinate product development and innovation. What comes next. Civil Investigative Demands are an evidence-gathering step, and the attorney general's office has not announced a lawsuit or a timeline. The company's response to the demands, and any findings from the parallel inquiry into Blue Cross Blue Shield of Texas, will indicate how far the state intends to take its review of insurer coverage practices. The outcome of the UnitedHealth Group investigation will fall to a leadership team that has been in place for only a few weeks.
Ken Paxton investigates UnitedHealth over alleged coverage denials. Posted: Oct 5, 2026 / 02:46 PM CDT Updated: Oct 5, 2026 / 03:59 PM CDT AUSTIN (KXAN) - Texas Attorney General Ken Paxton launched an investigation into UnitedHealth Group, alleging the health insurance giant engaged in deceptive and unlawful practices that may have denied Texans access to medically necessary care. According to the attorney general's office, allegations against the company include claims that it paid nursing homes to delay transferring patients to hospitals when additional medical care was needed. Additionally, in one case cited by Paxton's office, a Texas patient received approval from United for a procedure at RedBud Surgery Center in Austin, underwent the procedure, and later received a second letter rescinding that approval, leaving the patient responsible for a significant medical bill, according to the release. "Alarming reports keep piling up about how United treats Texas consumers," Paxton said in a statement. "I will not tolerate any insurance company putting illegal corporate greed over the people of Texas." Paxton said his office is seeking evidence to determine whether the company violated the Texas Deceptive Trade Practices Act and other state laws. As part of the investigation, the attorney general's office has issued Civil Investigative Demands to UnitedHealth Group to obtain documents and other evidence related to the allegations. UnitedHealth told KXAN they do not have a response to share at this time.
Texas AG probes UnitedHealth Group over coverage denials. October 05, 2026 01:46 PM CDT UnitedHealth Group is under investigation for allegedly illegally denying access to medically necessary care, the state of Texas disclosed Monday. States say rushed Medicaid work requirement implementation could jeopardize coverage for eligible enrollees.
Paxton investigates UnitedHealth over insurance coverage practices. Texas Attorney General Ken Paxton has launched an investigation into UnitedHealth Group over allegations that the company improperly denied patients access to medically necessary care and engaged in deceptive insurance practices. The attorney general's office said the investigation follows reports involving UnitedHealth's administration of health insurance benefits and coverage decisions. Among the allegations cited by Paxton's office is a case involving a Texas patient who received prior authorization for a procedure at RedBud Surgery Center in Austin. According to the attorney general's office, UnitedHealth later withdrew the approval after the procedure had been performed, leaving the patient responsible for a large medical bill. The state is also examining allegations that UnitedHealth made coverage decisions that improperly overrode the medical judgment of treating physicians. Paxton's office said it is investigating whether those practices could constitute the unlawful corporate practice of medicine or violate other Texas laws. The attorney general also cited reports alleging UnitedHealth provided financial incentives to nursing homes to avoid or delay hospital transfers for some patients. Those allegations have not been proven as part of the Texas investigation. Paxton has issued civil investigative demands seeking records and other information from UnitedHealth as his office examines possible violations of the Texas Deceptive Trade Practices Act and other state laws. The investigation does not establish that UnitedHealth violated the law. The investigation comes one week after Paxton announced a separate probe into Blue Cross Blue Shield of Texas over allegations involving prior authorization and delays or denials of medically necessary care. UnitedHealth Group had not publicly responded to the Texas investigation as of Monday morning.