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)

The Sr. Clinical Pharmacist role is a role which is primarily focused on collaborating within the Medical Rx team to research and develop new medical benefit cost management opportunities for high-cost drugs. This new position will report to the Director, Clinical Pharmacy, Optum Payment Integrity.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Identify, create, and develop a Medical Rx portfolio of cost savings initiatives that drive specific and measurable results for clients while providing timely and meaningful client updates
• Perform and participate in criteria development, analytical claim analysis, and sourcing, to support concept development of cost savings initiatives
• Establish solid matrixed relationships with internal stakeholders to define, align, and deliver payment integrity initiatives in support of assigned clients
• Influence senior leadership to adopt new ideas, approaches, and/or products
• Recommend changes to current product development procedures based on market research and new trends
• Industry thought leader and subject matter expert for medical claims, related trends, pricing, and cost management initiatives
• Lead concepts/projects from conceptualization to completion
  

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:

• Current and unrestricted pharmacist licensure
• 4+ years experience of auditing, billing, and/or coding claims in the medical benefit
• 4+ years of experience in the health care industry (Medicare, Medicaid, Commercial) with deep exposure to Payment Integrity or Revenue Integrity
• 3+ years of working experience and knowledge of CMS rules and regulations related to medical drug codes and services
• 2+ years of experience analyzing large claim data sets and applying results to identify trends/patterns
• 2+ years of experience presenting proposals to stakeholders and internal customers

Preferred Qualifcations:

• 3+ years of experience in claims adjudication or revenue cycle management
• 2+ years working as a Clinical pharmacist in a specialty Pharmacy, Managed care, or health plan
• 2+ years of assessing and monitoring Specialty drug trend in the medical benefit
• 2+ years of Project Management experience with excellent critical thinking and problem-solving skills
• 2+ years of experience working in a matrixed and highly adaptive environment handling tight deadlines
  

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $97,300 to $176,900. The salary range for Connecticut / Nevada residents is $97,300 to $176,900. 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 Policy.

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.