Nurse Practitioner Location: Worcester United States Requisition number: 2358834 Job category: Healthcare Delivery Job type: Onsite Time Type: part Time Overtime status: Exempt Travel: No Job Description: $40,000 Student Loan Repayment Or $20,000 Sign-on Bonus In this role, you will have the ability to achieve work life balance. Flexible scheduling is offered where providers can flex their time between 8am-8pm over the 7-day work week. No on-call, no weekends and no holidays required. Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere. As a team member of our Optum HouseCalls team, together in an interdisciplinary care environment, we help patients navigate the health care system and connect them to key support services. This preventive care can help patients stay well at home. We're connecting care to create a seamless health journey for patients across settings. Join us to start Caring. Connecting. Growing together. HouseCalls is an innovative, performance-driven program that brings care directly to members' homes. As a HouseCalls Advanced Practice Clinician (Nurse Practitioner or Physician Assistant), you will conduct annual in-home health assessments for Medicare Advantage and other plan members. This is a non-prescribing, field-based role focused on improving health outcomes through education, gap closure, and collaboration with primary care providers (PCP). Primary Responsibilities: - Conduct comprehensive in-home assessments, including: - Past medical history review, medication reconciliation, vital signs, and physical exam - Evidence-based screenings and point-of-care testing (as appropriate) - Identify and document diagnoses for care management and treatment planning - Communicate findings to members' PCPs to address gaps in care - Recognize urgent/emergent situations and intervene appropriately - Educate members on disease processes, medications, and compliance - Address social determinants of health and provide referrals as needed 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: - For NPs: Active ANCC or AANP certification in Family, Adult, Geriatric, or Adult-Gerontology Primary Care - Active, unrestricted licensure in the state you will be practicing in (or ability to obtain by start date) without current disciplinary actions or practice limitations - Active and unrestricted driver's license - In addition to a driver's license, access to reliable transportation to complete home visits - Ability to navigate varied home environments; ability to sit/stand/kneel as needed to perform assessments - Bilingual - English/Spanish - If you're working in a state that allows NPs to practice independently (without Collaborative Agreement), you must get approval from your licensing board-if required. New hires who are eligible but haven't applied yet must do so within 1 month of starting. If you're not eligible at the time of hire, you must begin working toward eligibility within 1 month and apply for approval within 3 months of becoming eligible Preferred Qualifications: - 1+ years of clinical experience (family, geriatric, or home health preferred) - Proficiency with electronic medical records and technology - Ability to transport equipment weighing up to 30 pounds and navigate stairs as part of home visits - Proven communication skills with geriatric or Medicare populations Compensation for this specialty generally ranges from $109,500 - $164,000. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. 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. 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. OptumCare 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Role Description As a Senior Advisor, you’ll provide strategy and analytical support for the Payment Integrity team inclusive of evaluating the current payment integrity programs, from pre-payment and post-payment editing, clinical coding audits, and recovery. You will help translate the payment integrity program performance and results into actionable insights, business cases and identify new savings opportunities. In this role, you will partner across finance, operations, clinical, network, claims, product and vendor teams to drive measurable progress toward enterprise affordability goals. - Support strategic medical cost analytics by identifying trends, risks, and affordability opportunities across cost containment and payment integrity programs. - Tell the story behind the data, translating complex findings into clear, executive-ready insights for technical, operational, and senior leadership audiences to short the strategic roadmap. - Own financial impact assessments and business cases for initiatives, including forecasts, variance analysis, and recommendations to improve performance. - Support program measurement and performance monitoring for pre-payment and post-payment editing, coding audits, and recovery programs across dashboards, scorecards, and executive materials. - Identify and size new opportunities by assessing billing patterns, coding and reimbursement dynamics, and drivers of wasteful or abusive practices. - Partner across the enterprise (e.g., Contracting, Coverage Policy, Commercial Payment Integrity, Compliance, Network Analytics, Claims, Reserving, Product) to align insights to decisions and execution. - Support vendor evaluation and sourcing through data-driven analysis that informs negotiations, pricing structures, and performance guarantees. - Advance reporting and analytics by improving data quality, strengthening controls, and enabling scalable/self-service solutions through automation and thoughtful use of AI-enabled tools. Qualifications - Bachelor’s degree in a quantitative field (e.g., Economics, Finance, Data Science, Data Analytics, Actuarial Science, Business, Public Health, Applied Mathematics) or equivalent experience, Master’s degree preferred. - Must be a Cigna retiree. - 20+ years of progressive experience in healthcare analytics, medical cost analytics, payment integrity, financial modeling, or related fields. - Strong analytical and technical skills, with hands-on experience using tools such as SQL, Excel, SAS, Tableau, Databricks (or similar platforms). - Proven ability to translate complex analyses into actionable business insights, with clear, confident communication for senior and executive audiences. - Knowledge of reimbursement methodologies and coding (e.g., MS-DRG, APCs, HCPCs, RBRVS) and familiarity with professional and facility claim constructs. - Comfort working in regulated and compliance-aware environments (claims operations, audit programs, policy, and related controls). - Strong collaboration and influence skills, with the ability to balance multiple priorities in a matrixed environment. - Self-starter with a strong orientation toward continuous improvement, ownership, and impact. Requirements - If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. Company Description Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

• Support strategic medical cost analytics by identifying trends, risks, and affordability opportunities across cost containment and payment integrity programs. • Tell the story behind the data, translating complex findings into clear, executive-ready insights for technical, operational, and senior leadership audiences to short the strategic roadmap. • Own financial impact assessments and business cases for initiatives, including forecasts, variance analysis, and recommendations to improve performance. • Support program measurement and performance monitoring for pre-payment and post-payment editing, coding audits, and recovery programs across dashboards, scorecards, and executive materials. • Identify and size new opportunities by assessing billing patterns, coding and reimbursement dynamics, and drivers of wasteful or abusive practices. • Partner across the enterprise (e.g., Contracting, Coverage Policy, Commercial Payment Integrity, Compliance, Network Analytics, Claims, Reserving, Product) to align insights to decisions and execution. • Support vendor evaluation and sourcing through data-driven analysis that informs negotiations, pricing structures, and performance guarantees. • Advance reporting and analytics by improving data quality, strengthening controls, and enabling scalable/self-service solutions through automation and thoughtful use of AI-enabled tools.

Role Description The Risk Prevention Analyst is responsible for providing operational risk assessments leveraging fraud mitigation tools, focusing on analysis, design, and artificial intelligence (AI) technology associated with fraud mitigation strategies, call queue creation, monitoring, support, and management using quantitative methods to review data and increase efficiency, productivity, effectiveness and savings. - Develop and implement Fraud strategies leveraging transaction data (credit/debit cards), machine learning models and advanced analytics tools to mitigate fraud losses and maintain superior customer experience. - Manage and optimize existing strategies effectively controlling risks due to first party and third-party fraud. - Coordinate the Risk Analytics team's tasks and ensure adherence to established turnaround times and SLAs. - Maintain awareness of member client fraud trends and suggest internal procedure changes to Risk Analytics Manager. - Supervise department workflow to ensure time-sensitive functions meet department standards. - Maintain productive relationships with all internal stakeholders including Fraud Operations, Risk Management, Product, Retail, Finance, and external vendors. - Advise internal contacts on sensitive issues and recommend client procedures and new product developments. - Create and deliver BI reporting for senior leadership, boards, and examiners. - Work closely with a designated client list to ensure efficient and effective fraud mitigation. - Participate in discussions with cross-functional teams to understand and collaborate on business objectives. - Translate recommendations into communication materials for peer review and management. - Identify and gather relevant data sources for recommended strategies through testing or exploratory data analysis (EDA). - Consult external clients and internal staff on fraud detection and prevention matters. - Monitor and analyze portfolio performance on an ongoing basis. - Leverage knowledge of fraud prevention tools to consult with clients on their fraud and risk goals. - Collaborate with other internal teams to serve as client advocate for fraud and risk items. - Ensure risks associated with business activities are effectively identified, measured, monitored, and controlled. - Responsible for reporting risks identified to the appropriate team and/or management. - Regular and reliable attendance is required; some on-call work is required. - This position may require early/late hours and availability during weekends. - Bring innovative thinking to solve problems and make recommendations. - Functional knowledge of common fraud patterns with curiosity to seek out anomalies. - The ability to prioritize and make quick decisions under tight deadlines. - Remain current with industry and client fraud trends. - Perform other duties as assigned. Qualifications - Bachelor’s degree in Business, Statistics, Mathematics, Computer Science, Engineering, or Economics or related field or combination of education and experience required. - Five (5) years within the financial service industry required. - Three (3) years professional experience in risk analytics, mitigating risk and/or fraud services required. - Payments processing system knowledge preferred. - Experience with Fraud Detection Work Center and/or FDR system experience required. - Strong analytical and problem-solving skills. - Deep experience working with fraud detection strategies, rules tuning, and fraud modeling. - Strong proficiency with SQL; ability to analyze large, complex datasets. - Experience with fraud orchestration and decisioning tools preferred. - Strong understanding of fraud metrics, forecasting methods, and false positive/true fraud tradeoffs. - Excellent problem-solving skills with the ability to synthesize complex data into actionable insights. - Strong communication skills – ability to communicate technical subject matter clearly. - Project management experience preferred. Benefits - Competitive wages - Medical with telemedicine - Dental and Vision - Basic and Optional Life Insurance - Paid Time Off (PTO) - Maternity, Parental, Family Care - Community Volunteer Time Off - 12 Paid Holidays - Company Paid Disability Insurance - 401k (with employer match) - Health Savings Accounts (HSA) with company provided contributions - Flexible Spending Accounts (FSA) - Supplemental Insurance - Mental Health and Well-being: Employee Assistance Program (EAP) - Tuition Reimbursement - Wellness program