Optum Prior Authorization Jobs in Utah (NOW HIRING)

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 Clinical Consultant serves as the primary liaison between OptumRx clinical operations, professional practice, clinical products and the Clinical Consultant's assigned Fee-for-Service Medicaid client . The role provides clinical support for OptumRx account management, operations, information technology, and other internal departments. Lead and manage ongoing contract relationships and pharmacy benefit analysis and consultation delivery to Medicaid clients. The 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. 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.
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 the client to establish achievable but aggressive clinical program goals, implementation and ongoing management of utilization management programs, improvement in medication adherence rates, improvements in therapy gaps for key chronic disease states, and preferred drug list (PDL) initiatives and support
• 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), where contractually appropriate
• Incorporate treatment and practice guidelines into client presentations including up-selling opportunities
• Comprehend and effectively explain formulary and clinical program changes to clients and internal departments
• Effectively manage client objections to new programs and required changes
• Identify and create opportunities to manage trend and add Optum products
• Formulate and deliver 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
• Collaborate in development of strategy as outward facing, dedicated or designated resource for assigned accounts, typically with direct client contact
• Bring innovative ideas that can be scaled across the organization
• Work in a collaborative manner with the Consultant(s) of assigned client(s) while maintaining focus on UHG and Optum strategies and goals
• Clearly communicate analytical and reporting needs to supporting departments
• Help clients be competitive within their market
• Identify opportunities to increase efficiency
• Manages/facilitates custom Pharmacy and Therapeutics (P&T) committees and Drug Utilization Review Board meetings for select clients, per contractual requirements
• Prepare meeting material
• Present recommendations, provide written analysis and respond to questions from the board members
• Review and recommend clinical prior authorization criteria
• Formulate, develop and provide to the P&T Committee recommendations for preferred drugs in each reviewed class
• Implement changes to the PDL and prior authorization requirements which will include modifications to the POS system and all supporting systems and documents
• Serve as the Prior Authorization Call Center Liaison
• Provide education for clients, pharmacists, members and physicians per contractual requirements
• Support sales and marketing including participating in RFP & Finalist activities, per department policies

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's degree in Pharmacy or Pharm D
• Current and unrestricted Pharmacist license
• 3+ years of experience working as a licensed pharmacist
• Experience working in a client-facing role with external clients (beyond patients and prescribers)
• Fee-for-Service Medicaid experience
• Experience developing and delivering formal presentations
• Proficient in Microsoft Office and Outlook
• Willing or ability to travel up to 10%

Preferred Qualifications:

• Clinical account management experience
• Experience working for a PBM and / or Health Plan in a client-facing role
• Experience working with complex public sector and government clients with complex benefit structures
• Experience with transition/implementation of clients
• Formulary Management experience
• DUR experience

*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.
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.