Optum Utilization Review Jobs in Missouri (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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

This role serves as the senior level liaison between Optum and key clients, typically at the Director or Vice President level.  Responsible for coordinating the activities of multiple internal departments to deliver best-in-class service to our clients.  Quarterbacks the account facing team responsible for developing client specific trend management strategies.  Strategic relationship manager responsible for client revenue retention and growth. This individual may or may not manage a team.  This is a high-performing individual with proven leadership skills and a comprehensive understanding of the PBM environment and broader healthcare system.  

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

Primary Responsibilities:

• Manages assigned accounts with a focus on client trend management, strategic plan development and execution, cultivating multi-level client relationships and manages staff outcomes, maybe direct and indirect 
• Manages client contract renewal activities with the primary goals of retaining client, obtaining multiple-year agreements, and maintaining or improving profitability 
• Accountable for understanding the primary business objectives of the client, developing, and managing shared goals, and demonstrating program value to the client 
• Understands OptumRx product and service offering, and can articulate the operational, clinical, and financial value of our programs to the client across multiple stakeholders with the goal of deploying new programs and services 
• Maintains consistent and regular client communications 
• Prepares and presents regular client performance reviews, including identification of cost drivers, recommendations for cost savings opportunities, utilization, and cost reports, and OptumRx industry news 
• Prioritizes and conducts regular on-site or telephonic client meetings as appropriate to proactively review client benefits, drug utilization and trend management strategies 
• Maintains a complete understanding of client contract terms including but not limited to the monitoring and reporting of performance guarantees. Ensures that all assigned contracts are monitored and reported as stated in the terms 
• Documents all client related activities as directed into the approved documents and or application 
• Manages and mentors account management team members 
• Specific topics may include the creation and delivery of client presentations, upsell techniques, implementation activities and daily client interaction 
• Provides staff with feedback at least quarterly on the level of accomplishment of personal and departmental goals 
• Establishes multiple corporate relationships and participates in client sponsored events/charities as appropriate.  Cultivates in-group growth through these relationships 
• Stays abreast of industry trends and developments and demonstrates solid communication skills in presenting these to clients and staff.  Demonstrates expertise in pharmacy benefit strategies and OptumRx Rx clinical programs 
• Provides leadership to client services team members in departmental and corporate initiatives 
• Provides regular feedback to management team regarding client metrics, client requirements and existing and new business development opportunities 
• Participates in sales preparation meetings and finalist sales presentations as necessary. 
• Ensuring client satisfaction 
• Provides support to other departments as requested 
• Exhibits compliant and ethical behavior in the performance of job responsibilities, including complying with all applicable federal and state laws and regulations, Code of Conduct, Business Ethics Policies and Procedures and other policies and procedures applicable to position 
• Actively participates in Compliance and Ethics Program, including attending annual compliance and ethics training and reporting suspected violations of the law or OptumRx's policies and procedures via OptumRx's Procedures for Reporting
• Incidents of Possible Improper Employment Practices, Misconduct, or Improper Financial/Accounting Practices 
• Follows all policies and procedures relating to job responsibilities and participates in the development and maintenance of departmental policies and procedures for Account Management, as appropriate 
• Management of book of business
• Secure renewal and upselling programs 
• Manage ongoing contract relationships and service delivery to clients for ten or more accounts
• Act as outward-facing, dedicated resource for assigned accounts, typically with direct client contact (not call center) and large or complex accounts 
• Build relationships with clients (not individual members) and partners with an OptumRx Pharmacy Services Specialist for overall and day-to-day service delivery
• Represent client internally and coordinates with other functions to implement client systems, complete projects, and address ongoing service needs

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:

• 5 years of Pharmacy Benefits Management Client relationship management or Account Management experience
• 3 years of experience with upselling PBM products and programs to clients  
• 2 years of experience with managing to client contracts  
• Experience presenting to senior level client leadership 
• Client facing presentation experience
• Advanced understanding of PBM industry including contracting 
• Ability to work in self-motivated environment with limited supervision
• Ability to potentially travel TBD, but could be up to 25% - 50% 
• Willing to work with clients in the central time zone 

Preferred Qualifications:

• Experience working on PBM client contract negotiations such as addendums and renewals
• Experience supporting Healthplan and downstream clients 
• Experience understanding of PBM financial terms and rebates 
• Microsoft Office Experience including Teams
• Familiarity with RxClaim; Tracker and Navigator 
• Demonstrated excellent verbal and written skills
• Proven solid oral and written communication 
• Proven solid negotiation skills 
• Proven ability to prioritize and meets deadlines 
• Proven ability to demonstrate professionalism both with internal and external clients 

*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.