RN Clinical Reviewer, CPC Medical Coding Academy - San Juan, PR

RN Clinical Reviewer, CPC Medical Coding Academy - San Juan, PR at UnitedHealth Group

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RN Clinical Reviewer, CPC Medical Coding Academy - San Juan, PR

Requisition number: 2361532 Job category: Claims Primary location: San Juan, San Juan Date posted: 05/04/2026 Overtime status: Non-exempt Travel: No

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At Optum, we deliver care, aided by technology, to help millions of people live healthier lives. Our work is driven by a culture of Caring. Connecting. Growing together. We value collaboration, innovation, inclusion, and accountability as we solve complex challenges across health care and public service.

Optum is part of UnitedHealth Group, a global organization committed to improving health outcomes, advancing health equity, and building a modern, high performing health system.

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.

Position Highlights:

The Reporting Manager - Medicaid Analytics SME serves as the overall Medicaid reporting and analytics lead for a large, enterprise scale Medicaid EDW and Analytics program. This role is responsible for overseeing federal and state Medicaid reporting, ensuring compliance with CMS requirements, maintaining audit readiness, and guiding the modernization of data analytics and reporting capabilities.

This position acts as a trusted advisor to customer executive leadership, providing strategic direction, risk awareness, and insight across Medicaid reporting, analytics, and data governance. The ideal candidate is a Medicaid Subject Matter Expert (SME) with strong leadership presence, excellent communication skills, and deep experience navigating complex, regulated reporting environments.

Primary Responsibilities:

• Medicaid Reporting & Compliance Leadership

• Lead enterprise Medicaid reporting, including ILMAR, CMS 64/21, MARS, T MSIS, PERM, and Quality of Care (QoC) measures

• As Medicaid Subject Matter Expertise (SME) own end to end reporting accountability: timelines, data validation, reconciliation, certification metrics, and submission readiness

• Ensure ongoing audit readiness and coordinate responses for CMS, PERM, IRS, and other regulatory audits

• Monitor and proactively address reporting risks, data quality issues, and compliance gaps

• EDW & Analytics Program Leadership

• Lead the Medicaid EDW analytics and reporting portfolio, including operational reporting, ad hoc analytics, and executive dashboards

• Provide strategic and tactical guidance to M&O and DDI teams on solution design, accuracy, and quality of deliverables

• Guide modernization of reporting and analytics platforms, including cloud based tools and architectures

• Partner with data engineering, architecture, QA, and operations teams to ensure reliable and scalable analytics solutions

• Client & Stakeholder Engagement

• Serve as a trusted advisor to state agency leadership, sister agencies, CMS, and external partners

• Present insights, recommendations, and risk considerations to executive and senior leadership audiences

• Anticipate customer needs and proactively propose analytic, reporting, and compliance solutions

• Facilitate alignment across business, technical, and vendor stakeholders

• Governance, Quality & Team Leadership

• Lead and influence cross functional teams, including analysts, developers, PMs, architects, testers, and SMEs

• Establish and enforce reporting standards, validation frameworks, and governance processes to deliver quality deliverables

• Review deliverables, provide guidance, and authorize deviations from standards when appropriate

• Mentor team members, support knowledge transfer, and contribute to succession and continuity planning

• Ensure alignment with contractual requirements, SLAs, and program objectives

About Optum Government Solutions (OGS)

Optum Government Solutions (OGS) partners with federal and state agencies to modernize health and human services programs through data, analytics, and technology. OGS leads large scale Medicaid Enterprise Data Warehouse (EDW), federal reporting, and analytics initiatives that support program integrity, regulatory compliance, and data driven decision making for state Medicaid agencies.

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.

#OptumInsightPJ

Required Qualifications:

• 10+ years of IT experience, including 5+ years leading data warehouse, analytics, and reporting initiatives
• 5+ years of healthcare analytics experience, with a strong preference for State Medicaid programs
• Demonstrated experience leading federal Medicaid reporting (e.g., CMS 64/21, ILMAR, T MSIS, PERM)
• Proven client facing leadership, including executive presentations and advisory responsibilities

Preferred Qualifications:

• Bachelor"s degree or higher in Analytics, Business Intelligence, Computer Science, Engineering, or a related field
• State Medicaid EDW or MMIS experience
• Strong technical background such as data analysis, SQL, ETL, BI
• Excellent written, verbal, and presentation communication skills
• Experience supporting audit sensitive environments and regulatory reporting
• Familiarity with modern analytics and BI platforms (Power BI, Tableau, SAP Business Objects, BI Query, Analytics Data/Engagement Platform)
• Experience with cloud based data platforms and tools (Azure, Snowflake, ADF, Python, Databricks, Symmetry)
• Knowledge/experience with legacy platforms and tools (Mainframe, ETL/Informatica, BI Query, Business Objects, SAS)
• Knowledge of Medicaid Enterprise Systems (MMIS, Provider Enrollment/PE, IES, TPL, PBMS, Drug Rebate) and other HHS programs/systems
• Knowledge of Agile delivery models and DevOps processes
• PMP, CBIP, or similar professional certification
• 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 $112,700 to $193,200 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.

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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.

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We have received recent reports of fraudulent LinkedIn messages and emails alleging or claiming to be sent from UnitedHealth Group, UnitedHealthcare, or Optum Executives.

The fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. These counterfeit-check cashing schemes exist and use a variety of deceptions to get people to cash these fraudulent checks.

UnitedHealth Group will never request you to pay a vendor or pay a fee of any sort to explore employment opportunities with our company.

If you wish to verify the legitimacy of any email alleging or claiming to have been sent by or on behalf of UnitedHealth Group Executives or Recruiters, please call 1-800-561-0861 between 7 a.m. and 7 p.m. CT, Monday - Friday, for assistance.

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At UnitedHealth Group, we are committed to giving back to the communities where we live and work, across the nation and around the world. Through charitable contributions and volunteering, our people are deeply and personally involved in building healthier communities.

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