Requisition Number: 2310945 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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. This position provides interpretation, execution, and report efficiencies and cost management of HEDIS Retrospective data for submission reporting of primary measures data as an effort to deliver a 4+ HEDIS/Star Performance rating with our Health Plans. Position works to conduct and manage outcomes of advanced analysis, reviews, forecasting, trending, and presents information to Business on system and data source capabilities for operational planning. Additionally, position produces innovative solutions driven by advanced analytics to provide predictive and prescriptive analytics to the enterprise, to ensure minimal risk to HEDIS/Star ratings and the Enterprise as a whole, reporting all impacts directly to VP. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Primary Responsibilities: - Responsible for managing/interpreting advanced analytics, including basic knowledge of understanding SQL queries and presenting findings to communicate strategic technical solutions to Executive Leadership on efforts that impact the bottom line - Manage multi-functional Teams of managers, developers and analysts to support and collaborate with WellMed business stakeholders - Supporting team with data verification, identifying and implementation of quality methods and standards of system procedures used to support department deliverables - Practicing conflict resolutions and presenting solutions to leadership to support with unique and complex problems that directly impact the business - Developing an audit process to measure quality assurance and ensure data integrity, conformity and accessibility, on performed deliverables conducted within department - Manages HEDIS/Star technical team on completion of initial audit documents, issues of sampling methodology, data collection strategies, and HEDIS measure interpretation - Analyzes and trends HEDIS rates, identifies barriers to improve rates and collaborates with cross-functional teams to resolve barriers - Provides leadership, analysis and technical guidance for implementation of HEDIS/Star Specifications - Stays current on all CMS, NCQA, and HEDIS/Star communications to align WellMed data submissions strategies to minimize risk to data submissions, audits, and overall scores - Takes an active role in mentoring, and team performance management process by completing goal setting, mid-year review, and year-end review on a timely basis and soliciting ongoing feedback and professional development with team - Develop strong relationships across the enterprise with staff members and stakeholders to strengthen the department - Act as a liaison for the leadership management team, provide updates and status reports on all NCQA HEDIS Quality Measures - Collaborate with internal and external business partners to gain understanding of their business needs - Performs all other related duties as assigned 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: - 5+ years of managerial experience and/or experience leading a technical team - 4+ years of experience working with Inter-Departmental teams - 4+years of experience supporting Executive Management with department budgeting and Strategic Planning - 1+ years of CMS Star and NCQA HEDIS knowledge - Basic understanding of SQL Server (Version 2005 or Higher) - Excellent analytical and problem-solving abilities Preferred Qualifications: - Health care industry experience - In-depth knowledge of HEDIS/Star regulatory requirements - Solid understanding of SQL and Informatics/ETL experience - Ability to lead change and achieve support for change; builds consensus - Solid verbal and written communication skills, with the ability to interface effectively with all levels of staff, including internalexternal customers and senior management teams Physical & Mental Requirements: - Ability to lift up to 10 pounds - Ability to push or pull heavy objects using up to 10 pounds of force - Ability to sit for extended periods of time - Ability to stand for extended periods of time - Ability to use fine motor skills to operate office equipment and/or machinery *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. 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 $110,200 to $188,800 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. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

• developing and executing a comprehensive data and analytics strategy for global supply chain • leading the creation and governance of accurate, reliable master data • designing standardized global processes • building tools, dashboards, and analytics for On-Time Delivery (OTD) and Working Capital Turns (WCT) • defining and implementing global analytics architecture • partnering with functional leaders to enable Oracle adoption and optimization • establishing a structured operating rhythm for consistent delivery and accountability.

Who is Fusion Technology? Fusion Technology is a performance-driven HUBZone Small Business concern residing in the heart of the beautiful mountainsides of West Virginia, steps away from the Federal Bureau of Investigation's Criminal Justice Information Services Division's Headquarters. Founded in 2007 by an Engineer-by-trade, Fusion Technology dedicates our valuable resources to providing comprehensive IT services and solutions to mission-critical US Government programs and the Intel Community. Position location: Remote (occasional travel to the main work site for special events) Who are you? Security-cleared Professional: You have an active DOD Secret security clearance. Experience is important to us: You have a Bachelor's degree with 7 years of experience Required Skills & Qualifications - Strong proficiency in Python and scripting (Bash preferred) - Hands-on experience with AWS services, particularly S3 and DynamoDB - Experience working with XML data formats and data transformation processes - Strong analytical and problem-solving skills with a focus on data quality - Ability to work with large datasets and perform exploratory data analysis - Effective communication skills for presenting technical findings to non-technical stakeholders Preferred Qualifications - Experience with data ingestion pipelines and ETL processes - Familiarity with data standardization and normalization techniques - Experience in search systems or entity resolution/analytics What you'll do: - Design, develop, and maintain Python-based data pipelines on AWS to support Entity Analytics (EA) and Consolidated Federated Search Results (CFSR). - Process and transform incoming XML data into structured, delimited records for downstream analytics and search applications. - Perform ad hoc and targeted data analysis to identify and resolve data quality issues, including missing, invalid, or inconsistent data. - Investigate data anomalies such as duplicate submissions, incorrect field usage, and broken associations. - Query and analyze AWS DynamoDB and S3 data using Python and Bash scripts to detect and validate potential issues. - Summarize findings and present insights, along with recommendations, to stakeholders. - Continuously improve data validation, querying efficiency, and overall data processing workflows. What matters to you matters to us. Fusion Technology values its employees and works hard to ensure proper care for them and their families. We desire to compensate employees in a competitive, motivational, fair, and equitable way with other employers in the marketplace. Salary is only one component of employee compensation but an integral part of recruiting and retaining qualified employees. However, at Fusion Technology, we take a comprehensive approach and consider each employee's needs to tailor a compensation plan that provides financial security and peace of mind. Our competitive package includes a best-in-class matching 401K program, a comprehensive healthcare plan through Cigna, a competitive employer contribution to a health savings account, vision and dental plans, life insurance, short- and long-term disability, and personal leave, in addition to paid certifications and training. Fusion Technology LLC is an Equal Opportunity Employer. We respect and seek to empower each individual and support the diverse cultures, perspectives, skills, and experiences within our workforce. Qualified applicants will receive consideration for employment without regard to sex, race, ethnicity, age, national origin, citizenship, religion, physical or mental disability, medical condition, genetic information, pregnancy, family structure, marital status, ancestry, domestic partner status, sexual orientation, gender identity or expression, veteran or military status, or any other basis prohibited by law.

About Us: Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. JOB SUMMARY: Domain: Healthcare Payer / Revenue Cycle Management | Programs: Medicare Advantage, ACA (Commercial Exchange), Medicaid | Platform: AWS | Role Type: Individual Contributor (hands‑on) We are seeking a hands‑on Senior Data Scientist with strong medical coding and clinical domain expertise to support risk adjustment and quality initiatives for Value‑Based Care programs across Medicare Advantage, ACA health plans, and Medicaid. This role focuses primarily on Risk Adjustment (HCC/RAF) and clinical indications, leveraging claims and clinical notes to deliver accurate, explainable, complete, and compliant analytics. The position is well‑suited for candidates with backgrounds in data science, biostatistics, bioinformatics, or clinical informatics, and experience applying traditional NLP and modern AI (LLMs, GenAI, agentic workflows) in regulated healthcare environments. ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member. Location: Remote within US only We are seeking a hands‑on Senior Data Scientist with strong medical coding and clinical domain expertise to support risk adjustment and quality initiatives for Value‑Based Care programs across Medicare Advantage, ACA health plans, and Medicaid. This role focuses primarily on Risk Adjustment (HCC/RAF) and clinical indications, leveraging claims and clinical notes to deliver accurate, explainable, complete, and compliant analytics. The position is well‑suited for candidates with backgrounds in data science, biostatistics, bioinformatics, or clinical informatics, and experience applying traditional NLP and modern AI (LLMs, GenAI, agentic workflows) in regulated healthcare environments. - Build and maintain risk‑adjustment analytic modeling (HCC suspecting, recapture models, RAF forecasting). - Apply NLP and GenAI to medical records and clinical notes to extract structured clinical evidence. - Develop LLM‑assisted and agentic workflows to support medical record coding review, evidence summarization, and improved productivity and accuracy. - Perform forecasting and scenario analysis tied to operational capacity and financial impact. - Monitor model performance, bias, drift, and documentation sufficiency. - Ensure analytics are explainable, auditable, and compliant. - Partner closely with Product, Engineering, Coding, Clinical, Compliance, and Operations teams. - Translate analytics into actionable signals embedded in payer workflows. - (Exposure to quality/HEDIS is a plus but not a primary focus.) - (Exposure to/knowledge of physician workflows and patient condition capture/documentation is a plus.) Required Skills & Experience - Strong foundation in statistics, applied machine learning, and data analysis. - Advanced Python and SQL. - Experience working with medical records, claims and clinical data. - Deep understanding of Risk Adjustment (CMS‑HCC, RAF mechanics). - Deep understanding of medical coding (ICD‑10, CPT, DRG, NDC) and clinical documentation workflows. - Experience delivering explainable models in regulated or audit‑sensitive environments. - Clinical background and cross-referencing to medical record documentation requirements. - Knowledge of CDI (Clinical Documentation Integrity) policies and procedures - Strong communication and cross‑functional collaboration skills. Technical & AI Stack - Languages: Python and SQL are required, R is a plus. - ML/DS model-building: pandas, numpy, scikit‑learn. - NLP/GenAI: Large Language Models (LLMs), prompt engineering, retrieval‑augmented generation (RAG) pipelines, agentic AI for task orchestration and review; clinical NLP frameworks such as scispaCy and BioBERT. - Data & Compute: AWS (RDS for SQL Server, S3, Redshift, Snowflake, Athena), Azure (Foundry, OpenAI Service, Machine Learning). - Analytics: Jupyter, Power BI. - MLOps: experiment tracking and model/version management (e.g., MLflow). Preferred Background - Experience supporting Medicare Advantage risk adjustment programs. - Experience with ACA health plan populations and Medicaid. - Background in bioinformatics, biostatistics, public health, biomedical informatics, or clinical data science. - Experience with medical record coding and CDI. - Familiarity with FHIR data and healthcare interoperability standards. - Prior work in payer RCM or value‑based care analytics. - Experience supporting compliance‑reviewed or audit‑exposed models. - Practical experience deploying or piloting LLM‑ or GenAI‑based solutions. PHYSICAL DEMANDS: Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.