Clinical Operations Manager Jobs in Philadelphia, MS

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 resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.  

The Senior Clinical Consultant serves as the primary liaison between OptumRx clinical operations, professional practice, and clinical products and the Clinical Consultant's assigned client base.  The role provides clinical support for OptumRx account management, operations, information technology, and other internal departments.  The Senior Clinical Consultant establishes client relationships and serves as primary point of contact for overall and day-to-day service delivery for clinical pharmacy needs.  This individual is relied upon to provide proactive clinical recommendations, information regarding pharmacy trend, clinical programs and products, and industry changes to clients, thereby fostering consultative relationships with large, complex and/or strategic clients.  This individual also represents client(s) internally and coordinates with other functional areas to implement client initiatives, complete projects, and address ongoing pharmacy service needs.  The Senior Clinical Consultant is expected to maintain strategic relationships with client leaders, key stakeholders, and brokers/consultants.   In addition, the Senior Clinical Consultant supports the clinical pharmacy team with formulary development, clinical program development and clinical pharmacy functions as the need arises.  The Senior Clinical Consultant serves as a subject matter expert (SME) for other departments on Clinical Consulting-specific issues and provides mentorship to less experienced Clinical Consultants.  

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

Primary Responsibilities:

• Provide superior clinical consultation and clinical account management with a focus on client satisfaction, client retention, and trend management
• Collaborate with clients to establish achievable but aggressive clinical program goals, including generic dispensing rate improvements, implementation of utilization management programs, improvement in medication adherence rates, improvements in therapy gaps for key chronic disease states, formulary compliance targets, and HEDIS & NCQA measures where applicable
• Communicate drug information to clients and respond to plan-specific clinical inquiries
• Stay aware of and provide clinical market intelligence to clients
• Identify opportunities for clinical program up-sell and spearhead up-sell to assigned client(s)
• Incorporate treatment and practice guidelines into client presentations including up-selling opportunities
• Comprehend and effectively explain formulary and clinical program changes to clients
• Effectively manage client objections to new programs and required changes
• Identify and create opportunities to manage trend and add OptumRx products
• Formulate client recommendations based on available data and trend
• Deliver clinically sound and fiscally responsible recommendations to clients based on their trend
• Routinely collaborate with account management to provide clinical aspects of client quarterly reviews
• Analyze & interpret benefit designs
• Demonstrate critical thinking by analyzing relevant information with multiple methods
• Generate innovative ideas that can be scaled across the organization
• Develop clinical strategy as outward-facing, direct client contact for large, complex and/or strategic accounts
• Clearly communicate analytical and reporting needs to supporting departments
• Help clients be competitive within their market
• Identify opportunities to increase efficiency
• Lead and manage ongoing contract relationships and pharmacy benefit analysis and consultation delivery to clients
• Manages/facilitates custom P&T committees for select clients, per contractual requirements
• Provide education for clients, pharmacists, members and physicians per contractual requirements
• Support sales and marketing including participating in RFP & strategic Finalist activities, per department policies
• Serve as subject matter expert in one or multiple areas and represent Clinical Consulting department in these areas - internally and externally
• Assist in training new Clinical Consultants - in part or in whole
• Assist in development of existing Clinical Consultants
• Provide administrative/management/leadership back-up support to Director as necessary
• Drive enhanced client relationships through senior-level strategic discussions and planning which addresses issues of highest priority to the client
• Maintain familiarity with assigned client contract terms; particularly pricing of clinical programs/services, and is able to actively engage in contract renewal negotiations as needed
• Consistently look at existing processes, methods and materials to find opportunities for improvement
• Maintain strategic relationships with client leaders, key stakeholders, and brokers/consultants while maintaining focus on UHG and Optum strategies and goals
• Serve as Subject Matter Expert (SME) for other departments on Clinical Consulting-specific issues/inquires
• Routinely identify, develop and share best practice experience with peers
• Mentor new clinical consultants when requested
• Mentor clinical consultants on the team when requested  

 
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 Doctor of Pharmacy degree 
• Active, unrestricted US state-specific pharmacist license
• 5 years of pharmacy practice experience or equivalent
• 3 years of client facing or clinical account management experience
• 3 years of PBM experience
• 2 years of experience providing formal client presentations
• Experience managing multiple clients simultaneously
• Experience prioritizing customer-centric activities
• Basic competency in Microsoft Word, Excel, PowerPoint, Teams, and Outlook
• Ability and willingness to travel up to10% of the time

Preferred Qualifications:

• Specialty Pharmacy experience
• Medicaid experience
• Intermediate level competency in Microsoft Word, Excel, PowerPoint, Teams and Outlook

*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.