The Clinical Pharmacist on the Clinical Coding Consulting team serves as the primary liaison between OptumRx's Formulary & Utilization operations, Benefit Operations Management and the Clinical Consultant. The role provides clinical coding support for OptumRx clinical consultants, benefit operations management (BOM), information technology, and other internal departments. This individual is relied upon to provide custom formulary & utilization management coding consultation & work to the clinical consultant client facing teams on formulary & utilization management set up in the RxClaim adjudication system & related formulary management applications.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:- Provides consultative guidance for standard & custom formulary changes in RxClaim, RxBuilder & related clinical applications (RxAuth, RxInteract)
- Conducts 2ND Level Formulary/UM Claim Research
- Implementation clinical coding support for BDS/cBDT/RxConstruct questions
- GPI Reclass support/global Coding Change Support Drug utilization management
- Commercial clinical audit support
- Manage custom formulary coding work post client sign off
- Translate client intent to code-able language for BOM team
- Evaluate / resolve new rule design & conflicts with existing formulary coding
- New Client Implementation coding support for custom formulary/UM programs
- Extracts, evaluates and interprets clinical coding in adjudication & formulary management systems
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:- Bachelor of Science in Pharmacy or PharmD
- Current and unrestricted Pharmacist license (any U.S. state)
- 2+ years of experience working as a Clinical Consultant or Clinical pharmacist working in Formulary/UM operations or Benefit administration
- Experience conducting claims/coding research and analysis
- Experience working within a PBM
- Experience working in RX Claim or other claims adjudication system
- Intermediate to Advanced Proficiency with Microsoft Excel
- Proven ability to navigate MS Office and a Windows based environment and the ability to create, edit, save, and send documents utilizing Microsoft Word; ability to navigate Outlook and conduct Internet searches
Preferred Qualifications:- MBA or other related advanced business degree
- Experience using Microsoft Access or other database/query tools
- Experience with Medi-Span drug classification system
- Client-facing experience (beyond patients and prescribers)
*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 $91,700 - $163,700 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.
