Job Description

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)At OptumRx, a part of the UnitedHealth Group family of businesses and one of the largest pharmacy benefits managers in the United States, we're dispensing with tradition. Join us as we take on the challenge of reinventing the health system. As a Clinical Pharmacist, and you'll play an important role in enhancing clinical pharmacy programs such as drug utilization review, prior authorization, health outcomes, disease state management, care management and other specialty programs. It's an exceptional opportunity to join a pharmacy team with a focus on clinical and business collaboration. Join us today and start helping making a difference in the lives of millions. Join us and use your diverse knowledge and experience to make health care work better for our patients. As a Clinical Pharmacist in Clinical Quality Management, you will be responsible for compliance and regulatory initiatives and/or quality and process improvement projects for the clinical department. You’ll enjoy the flexibility to telecommute* from anywhere within United States as you take on some tough challenges.Primary Responsibilities:Perform case reviews of Clinical Quality Oversight ProgramsMaintain close working relationships / dialogue with key customers (internal and external) to help ensure optimal quality and compliance in clinical products and servicesInterpret and apply CMS, URAC, NCQA and other clinical regulatory requirements pertinent to the PBM / managed care industryDevelop and measure impact of quality initiatives to proactively address CMS, URAC, NCQA and other regulatory requirementsDefine and oversee clinical process improvement projects to increase operational efficiency and improve accuracy of core clinical functionsDocument and maintain all clinical quality and process improvement projectsEnsure all clinical Policies & Procedures (P&Ps) and Standard Operating Procedures (SOPs) are developed, maintained and accurately reflect daily activitiesOther activities as determined by the Senior Director, Clinical ServicesYou’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:Pharm D or Bachelor of Science in PharmacyCurrent and unrestricted Pharmacist license in residing state 3+ years of experience working as a licensed PharmacistSolid clinical analytics with ability to analyze / interpret PA / Appeals, MTM / EMR data, trendsAbility 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 searchesPreferred Qualifications:Managed care or PBM experience (e.g., Prior Authorization, Medication Therapy Management)Quality Improvement experienceCMS, URAC, NCQA and other clinical regulatory requirement experienceSolid interpersonal / communication skills, thrives in dynamic relationships and working cross-functionallyUnitedHealth Group is working to create the health care system of tomorrow. Already Fortune 5, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.Careers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you’ll fill far more than prescriptions. As a member of one of our pharmacy teams, you’re empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter PolicyFor more information on our Internal Job Posting Policy, click here.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.Job Keywords: Pharmacist, Pharm D, Prior Authorization, Appeals, MTM, EMR Data, CMS, URAC, NCQA, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, RemoteBrand: OptumRxJob ID: 943532Employment Type: Full-timeJob Area: Clinical

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