Jobs at Optum

Perform in-home long-term care insurance assessments: collect demographics, physician and medication information; complete brief cognitive screening; evaluate ADL/IADL functional independence; document in real time using a point-of-care web application on a laptop or tablet.

Provides office-based gastroenterology consultations and medical management, including pre-colonoscopy screenings and diagnosis and treatment of gastrointestinal conditions. Sees approximately 18–20 patients daily, works independently with clinical support, and collaborates with the care team. The role follows a Monday–Friday schedule with no call, weekends, or nights.

Provides direct patient care across multiple clinical sites as a floating Medical Assistant. Collects vitals and patient history, assists with injections, EKGs, phlebotomy, documents in EMR, prepares exam rooms, coordinates care, and supports phone and remote outreach as needed.

Provide comprehensive primary care to adult patients through chronic disease management, wellness visits, screenings, consultations, and follow-ups. Maintain a quality-focused patient care model while collaborating with multidisciplinary healthcare providers. Work Monday through Friday with dedicated administrative time, medical assistant support, and office resources. Candidates must hold appropriate medical credentials, California licensure, DEA and BLS certification, and have primary care experience.

Drives territory growth for Optum Infusion Pharmacy by generating referrals from immunology and neurology specialists, developing healthcare customer relationships, executing territory plans, and achieving sales goals. Partners with strategic account executives, manufacturing partners, and internal intake, operations, and nursing teams. Travels throughout the Los Angeles market to meet clinics and hospitals and attends occasional evening or weekend events.

Conducts onsite and desktop pharmacy network audits, including pre-audit planning, claims discrepancy identification, regulatory and records compliance reviews, provider communications, findings reports, and audit quality control. The role requires independent investigation, pharmacy claims processing knowledge, advanced Microsoft Office skills, pharmacy technician licensure and PTCB certification, remote work, and travel of up to 75% annually.

Verify and dispense medication orders, provide clinical pharmacy services including medication therapy management and pharmacokinetic dosing, oversee sterile and non-sterile compounding, collaborate with physicians and nursing teams, supervise pharmacy technicians and interns, monitor medication safety and patient outcomes, and ensure regulatory and accreditation compliance.

Performs patient care procedures under clinician or RN supervision, including examinations, vital signs, medication administration, testing, specimen collection, telephone screening, and patient flow support. Maintains clinical areas, equipment, records, inventories, and audit readiness. Coordinates prescriptions, hospitalizations, and bed-day tracking while providing safe, compliant care.

Maintains provider demographic, contract, location, roster, and termination data across enterprise systems. Processes updates, validates records, conducts audits, generates reports, resolves provider and claims-related discrepancies, investigates payment issues, and supports regulatory compliance, system enhancements, and process improvements. Collaborates with Claims, Credentialing, Finance, Customer Service, Network Management, and external providers to ensure accurate provider information, claims processing, payments, and provider network operations.

Leads provider performance and quality improvement initiatives through advanced chart reviews, healthcare data analysis, dashboard maintenance, training coordination, mentoring, workflow development, regulatory monitoring, and stakeholder presentations. Focuses on improving HEDIS, STAR, and Risk Adjustment outcomes while supporting provider engagement and cross-functional strategic initiatives.

This role involves reviewing appeals and grievances in a healthcare setting, ensuring compliance with regulations, and providing clinical input for decision-making.

Provides inpatient pharmacy services, including medication order verification and dispensing, clinical medication therapy management, pharmacokinetic monitoring, compounding oversight, medication safety, and collaboration with hospital care teams. Supervises pharmacy technicians and interns, supports daily operations, and ensures compliance with USP, Joint Commission, state, and federal requirements.

Supports hospital admissions, transfers, and discharges by updating ADT and registration systems, verifying insurance eligibility, correcting demographics, printing patient documents, notifying payers, and escalating financial clearance issues. Ensures accurate and timely patient registration while complying with HIPAA, PHI, ABN, MSP, EMTALA, and related regulations. The role is fully onsite, requires a four-day workweek with extended hours, and supports continuous hospital operations.

Provides direct clinical support for palliative care patients by collecting and documenting health information, assisting with examinations and procedures, performing tasks such as injections, EKGs, and phlebotomy, coordinating care, maintaining accurate EMR documentation, and preparing treatment rooms while following infection-control protocols.

Support clinic operations by preparing patient charts in the EMR, conducting pre-visit outreach, reconciling data, managing referrals and tasks, coordinating care with multidisciplinary teams, and assisting with scheduling and follow-up to ensure efficient patient care.

Conduct investigations into healthcare fraud, waste, and abuse using claims data and regulatory guidance. Collect evidence, perform interviews/fieldwork, document findings, support legal proceedings, collaborate with state/federal partners, and maintain SIU case records. Ensure regulatory compliance and contribute to settlement negotiations.

Registers patients across hospital departments, verifies demographic, insurance, and financial information, obtains signatures and required documentation, processes payments, supports regulatory compliance, and follows emergency department and downtime procedures. The role also assesses self-pay eligibility and handles specialized cases such as workers’ compensation, domestic violence, and incarcerated patients.

Leads healthcare regulatory initiatives, compliance projects, audits, and stakeholder consultations. Interprets CMS, DMHC, DHCS, NCQA, and related requirements; coordinates responses to regulators; assesses risks; develops executive reporting; and drives process improvements across clinical and operational functions. Requires extensive healthcare regulatory or compliance experience, managed care knowledge, cross-functional project leadership, strong analytical and communication skills, and the ability to influence stakeholders in a changing environment.

Conduct hands-off long-term care insurance assessments in claimants’ homes. Gather demographics, physician information, and medication lists; evaluate functional independence, ADL and IADL abilities, and cognitive status. Document findings in real time using a web-based point-of-care system on a laptop or tablet. The role requires unrestricted RN licensure, CPR certification, dependable transportation, and the ability to work independently in varied home environments.

Serve as liaison between Optum and provider network, responding to provider issues, supporting onboarding and data management, maintaining provider records, preparing performance reports/scorecards, conducting outreach for quality measures (HEDIS, CMS, CAHPS), and supporting provider retention and escalation management.