Remote Utilization Management Pharmacist Jobs in Raleigh, NC

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.

Lead and manage ongoing client relationships, pharmacy benefit analysis and consultation delivery to clients.  Collaborate in development of strategy as outward-facing, dedicated resources for assigned accounts, typically with direct client contact for large/complex accounts.  Builds client relationships and serves as primary point of contact for clinical specialty pharmacy needs.  Represents client(s) internally and coordinates with other functions to implement client systems, complete projects, and address ongoing pharmacy service needs.  

The Specialty Operation Manager is responsible for day-to-day management of the Specialty program, including issue escalation and resolution, operational, reporting, data and analytical needed and Specialty performance. Additionally, the Specialty Operation Manager will support the Specialty team on execution on all clinical strategies, patient care support, Specialty Drug List consultation and quality initiatives as well as participate in quarterly business reviews detailing pipeline tracking, including forecasting, key performance indicator (KPI) review, strategic guidance, and comprehensive medical management initiatives. 
 

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

Primary Responsibilities:

• Support routine reporting to client management leadership regarding milestone attainment and any significant issues within their segment that may be impacting overall team performance
• Maintains understanding of individual client contracts and ensures proper execution of all relevant deliverables specific to those agreements
• Work with the Client Management Leadership Team to drive and execute toward strategic goals and objectives
• Collaborates with clients to establish achievable but aggressive specialty program goals, including support on patient care support, Specialty Drug list consultation and quality initiatives
• Formulates and delivers clinically-sound and fiscally responsible recommendations to clients based on trend
• Create action plans to address any client satisfaction concerns
• Stays aware of and provides market intelligence to clients on specialty pharmacy products
• Provides education for clients, pharmacists, members and physicians per contractual requirements
• Supports strategies around other revenue-enhancement efforts (e.g., specialty, formulary, UM, mail, etc.) in coordination with client mgmt./sales teams where appropriate
• Routinely collaborates with client management leadership peers to provide well-coordinated, impactful quarterly performance review sessions with clients
• Serves a key resource for new clinical product/service ideation and liaison to clinical product development / management areas to create new or enhance existing programs
• Identifies and collaborates with clinical management leadership on specialty management strategies
• Drives enhanced client relationships through senior-level strategic discussions and planning which addresses issues of highest priority for the client
• Consistently looks at existing processes, methods, and materials to find opportunities for improvement
• Maintains strategic relationships with client leaders, key stakeholders, and brokers/consultants
• Serves as Subject Matter Expert (SME) for other departments on Specialty Pharmacy-specific issues/inquiries
• Lead departmental and interdepartmental workgroup and project work
  

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 PharmD 
• Active, unrestricted US state-specific pharmacist license
• 3 years of experience in PBM 
• Experience with specialty pharmacy 
• Experience with total cost of care
• Experience with account management and reporting
• Advanced proficiency in delivering presentations to various audiences 
• Proficient skills in Microsoft Office and Outlook 
• Willing to work with clients and colleagues across various time zones
• Ability to travel up to 10%
  

Preferred Qualifications:

• 2 years of PBM account management experience
• 2 years of experience supporting PBM Healthplan clients
• Experience giving formal presentations  
• Experience in data analytics and drawing insights 
• Experience in Rx Claim
• Experience in MediSpan
• Advanced understanding of PBM industry

*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.