Carmel, Indiana
Houston, Texas
Nashville, Tennessee
Nashville, Tennessee, Tennessee
Anchorage, Alaska, Alaska
Atlanta, Georgia, Georgia
Marlboro, New Jersey
Morristown, New Jersey
Posted: 20-Dec-24
Location: Eden Prairie, Minnesota
Categories:
Internal Number: 145318421
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 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.
Optum, the fast-growing part of UnitedHealth Group, is a leading information and technology-enabled health services business. Our teams are dedicated to modernizing the health care system and improving the lives of people and communities.
Serving virtually every dimension of the health system, we work with a diverse set of clients across 150 countries – from those who diagnose and treat patients to those who pay for care, deliver health services, and those who supply the cures. Optum maintains operations across North America, South America, Europe, Asia Pacific and the Middle East. Our innovative partnerships provide technology and tools that enable unprecedented collaboration and efficiency. As a result, we can tap into valuable health care data to uncover insights and develop strategies for better care at lower costs.
About the Role:
At UnitedHealth Group and Optum, we want to make healthcare work better for everyone. This depends on hiring the best and brightest. With a thriving ecosystem of investment and innovation, our business in Ireland is constantly growing to support the healthcare needs of the future.
OptumRx offers industry leading utilization management (UM) programs to support formulary strategies through the development and maintenance of over 6000 coverage policies and related claim adjudication logic. The OptumRx Pharmacy & Therapeutics Committee reviews the clinical basis for coverage requirements no less than annually and more often when new clinical information becomes available to ensure alignment with evidenced based standards in care.
The Clinical Utilization Management Pharmacist Manager oversees a team of pharmacists and analysts supporting UM programs through evidenced-based, ethical, and regulatory compliant practices.
Working Schedule:
This is a full-time telecommute position with working hours of 5 days a week.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities: Manager
- Solid therapeutics knowledge with ability to interpret medical literature, clinical practice guidelines, competitive intelligence, industry and market trends to oversee coverage criteria development and maintenance for Commercial, Medicare, Medicaid and Exchange lines of business
- Ability to present clinical coverage policies and concepts to the OptumRx National Pharmacy & Therapeutics (P&T) committee
- Self-starter who collaborates across the organization to develop new strategies and support UM related initiatives
- Oversee the development and maintenance of policies and work related to clinical content in support or drug coverage programs including coding, claim adjudication and operational set-up necessary for prior authorization review
- Oversee biannual negative change cycle for Commercial line of business to ensure timely implementation of programs and accurate publication of member and provider facing documents
- Knowledge of prior authorization practices to provide consultation to key stakeholders including; account management, operations, industry relations, specialty and pharmacy practice teams
- Oversee the custom criteria development process working closely with account management to ensure alignment of coverage policies to plan’s scope of benefit
- Knowledge of medications and coverage practices for medications covered under the medical benefit
- Collaborate and lead cross-functional teams with Drug Intelligence, Pipeline, Industry Relations, Clinical Utilization Management and others with ability to synthesize clinical evidence to provide recommendations to providers, committees, and senior leadership.
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:
- PharmD or BS in Pharmacy
- Current pharmacist licensure in good standing (within state of residency)
- 2+ years of People/team/project leadership experience
- 2+ years of Managed Care/PBM experience with knowledge of utilization management practices
- Proven solid written & verbal communication skills with proficiency in MS Office applications
- Proven solid desire to lead and teach colleagues in the dynamic environment of a top Fortune Global company
Preferred Qualification:
- Advanced clinical training or experience a plus e.g., accredited residency program
Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $104,700 to $190,400 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
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.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
