Optum Utilization Review Jobs in Michigan (NOW HIRING)

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 full time, exempt, CPS Staff Pharmacist at Cadillac Hospital (part of the Munson Medical Center Health System) you will fill orders with accuracy; check technician-prepared products before release; maintain security of pharmacy and controlled substances; enter orders and patient information with accuracy; aid in the training of new staff; update the Director about the daily activities of the pharmacy; and aid the Director in maintaining the pharmacy.

Schedule: This position is scheduled to work at least 40 hours per week, Monday through Friday with some on call. There are no nights, weekends or holidays.

About the Facility: Cadillac Hospital has received a 5-star CMS rating for overall hospital quality, one of just 10 hospitals in Michigan to receive this top rating based on quality measures. You can be assured your care will be excellent, safe, and delivered with warmth and friendliness because our physicians and staff care for you - and about you. Cadillac Hospital is part of Munson Healthcare, Michigan's largest and leading health care system consists of the Munson Team of medical experts, nine award-winning community hospitals, and related organizations serve people in 30 counties.

The Foster Family Community Health Center, formerly called the Munson Community Health Center, is the front door to services provided at Munson Medical Center and elsewhere in the Munson Healthcare system. People from around northern Michigan use Foster Family Community Health Center for pre-operative testing, pain management, rehabilitation therapies, urgent care, sleep disorders, and many other diagnostic services.

About the Pharmacy: The Specialty Pharmacy will utilize PioneerRx or a similar program. The Pharmacy hours will be Monday-Friday from 8am to 5pm.

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:

• Pharmacy degree (BS or PharmD) from an ACPE accredited school of pharmacy; PharmD preferred
• Current Pharmacist license in good standing in Michigan
• Experience using computer applications including word processing, spreadsheets, and pharmacy information systems
• Proven ability to work independently, set priorities, make critical decisions, and respond to client concerns
• Demonstrated accuracy and timeliness in a work setting
• Demonstrated effective communications skills; verbal and written

Preferred Qualification:

• 1+ years of experience in a pharmacy position in a hospital, specialty or retail setting

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). The hourly pay for this role will range from $44 - $79 per hour 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 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 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.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.