Manager Utilization Management Jobs in Appleton, WI

Explore opportunities with CPS, part of the Optum family of businesses. We're dedicated to crafting and delivering innovative hospital and pharmacy solutions for better patient outcomes across the entire continuum of care. With CPS, you'll work alongside our team of more than 2,500 pharmacy professionals, technology experts, and industry leaders to drive superior financial, clinical, and operational performance for health systems nationwide. Ready to help shape the future of pharmacy and hospital solutions? Join us and discover the meaning behind Caring. Connecting. Growing together.    

As a Specialty Pharmacist you will provide high-touch support to patients with complex, specialty diseases, helping them achieve better outcomes through personalized care and consistent engagement. You'll enroll and retain patients, deliver exceptional service, and act as a trusted resource throughout their therapy journey to maximize their access to pharmacy care. Responsibilities include resolving drug-related issues, educating patients and healthcare providers, coordinating clinical and billing projects, and contributing to formulary and compliance efforts. You'll also serve as a specialty medication expert, continuously expanding your knowledge through research and writing.

Primary Responsibilities:

• Review and manage specialty medication therapies for complex, chronic, or high-cost conditions
• Provide patient education and counseling, focusing on adherence, administration, side effects, and outcomes
• Coordinate care with providers, payers, and manufacturers to ensure therapy access and continuity
• Oversee prior authorizations and utilization management, ensuring compliance with payer and program requirements
• Monitor effectiveness and safety of therapy, including lab values, adherence metrics, and patient-reported outcomes
• Ensure compliance with REMS and accreditation standards, including documentation and reporting requirements
• Support quality initiatives and outcomes reporting, meeting specialty pharmacy performance and regulatory metrics
  

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:

• ACPE - accredited PharmD degree (highly preferred) or BS of Pharmacy with recent pharmacist work experience
• Active State of Wisconsin pharmacist license in good standing 
• Proficient in Microsoft Office (Word, Excel, PowerPoint, Outlook)
  

Preferred Qualifications:

• MS Pharmacy and/or Board certification
• 1 years of recent pharmacist experience (hospital setting preferred)
  

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 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.