Utilization Management Assistant Jobs in Colorado

We are seeking a talented individual to join our team at Mercer. This role can be based in Atlanta, Chicago, Denver, Houston, Los Angeles, Phoenix, Portland & San Francisco, and offers a hybrid work arrangement, requiring a minimum of three days per week in the office.

As a Clinical Pharmacy Consultant you will work as part of the clinical team responsible for assisting in the management of complex clinical cases that often result in evaluation of high-cost claimants and will serve as the pharmacy subject matter expert for internal and external clinical partners collaborating on cases and providing education on specialty medication management. The role requires a strong understanding of specialty medication products, site-of-care redirection, channel management, medical necessity and prior authorization criteria, utilization management strategies, complex disease management and an understanding of the pharmacy medication pipeline.

We will count on you to:

• Act as the specialty pharmacy resource for your assigned clinical team(s) to assist in the identification and management of potential and actual high cost claimants.
• Interpret pharmacy data reporting shared by the benefit administrators and leverage this information for selection of HCC cases for review.
• Participate in discussions with the benefit administrators' clinical teams to identify strengths and opportunities in how the case is being managed and offer suggestions to shape the course of the member's care moving forward.
• Work to create summary reports to Mercer H&B teams, coalition partners and/or clients in a clear and constructive manner.
• Participate in Pharmacy Practice meetings and ensure Mercer's point of view on effective pharmacy clinical management strategies is effectively communicated.
• Incorporate compliance and professional standards into all work processes, including transparency, peer review and maintaining required licensure.
• Monitor success of projects in terms of client satisfaction, scope, and timeliness of deliverables.
• Establish effective carrier/vendor relationships to represent Mercer and to serve our clients.
• Provide mentoring and coaching to team members on specialty medications and pharmacy management.
• Assist in the development of ongoing training presentations, and other learning collaterals used to influence care outcomes and demonstrated ability to use various communication modes and tailor presentations of technical information to various audience levels.
• Support wellness consulting projects by providing pharmacy subject matter expertise to cross-functional teams working in areas such as chronic conditions management, ensuring pharmacy insights meaningfully shape clinical and financial outcomes for our clients.
• Advance clinical program effectiveness by conducting pharmacy assessments to support Mercer's clinical care management model across various managed care organizations.
• Assist with other consulting projects as needed.
• Thrive and be motivated by an environment that embraces AI and technology-enabled tools.

What you need to have:

• Active, unencumbered Pharmacy license.
• At least 7+ years relevant work experience in clinical pharmacy.
• Ability to navigate MS Office Tools (Word, Excel, PowerPoint, Teams).
• Clinical acumen to evaluate specialty medication regimens, make evidence-based recommendations and suggestions to shape the course of the member's care moving forward.
• Proven organizational skills with ability to prioritize and handle multiple tasks in a demanding work environment.
• Strong communication skills with ability to share highly technical information in a non-technical fashion; strong business writing skills.
• Ability to partner and lead teams to produce client deliverables.
• Ability to work independently and on a team.

What makes you stand out:

• Pharm.D. degree from an accredited college of pharmacy.
• Certified Specialty Pharmacy (CPS) with the National Association of Specialty Pharmacy.
• Experience supporting infused specialty medications.
• Experience in managed care settings.
• Background in case management review of specialty medications, including site-of-care review.
• Experience conducting prior authorization reviews.
• Clinical payer (carrier) experience, including demonstrated clinical leadership.

Why join our team:

At Mercer, we're as invested in creating brighter futures for our own people as we are for our clients. To help you reach your full potential, we offer a culture, benefits program and resources that support your wellbeing and career development as well as:

• The opportunity to work with some of the smartest and most energetic people in the industry, who will coach, challenge and enable you.
• A dynamic, collaborative and inclusive culture, where diversity is embraced – and you are celebrated and appreciated for who you are.
• The opportunity to network, share views, and learn from others by getting involved with our Business Resource Groups: PRIDE, Women@Mercer, Racial & Ethnic Diversity, AccessABILITIES and Rising Professionals Network.
• The chance to make a positive difference in your local community by using your paid time off to volunteer through events organized by Mercer Cares, our community outreach and volunteerism BRG.
• A huge variety of virtual learning and development resources to support your personal and professional growth.
• Competitive rewards supporting your financial wellbeing, including compensation, retirement savings, stock purchase plan, and more.

Mercer is a business of Marsh (NYSE: MRSH), a global leader in risk, reinsurance and capital, people and investments, and management consulting, advising clients in 130 countries. With annual revenue of over $27 billion and more than 95,000 colleagues, Marsh helps build the confidence to thrive through the power of perspective. For more information about Mercer, visit mercer.com. Marsh is committed to embracing a diverse, inclusive and flexible work environment. We aim to attract and retain the best people and embrace diversity of age background, disability, ethnic origin, family duties, gender orientation or expression, marital status, nationality, parental status, personal or social status, political affiliation, race, religion and beliefs, sex/gender, sexual orientation or expression, skin color, veteran status (including protected veterans), or any other characteristic protected by applicable law. If you have a need that requires accommodation, please let us know by contacting reasonableaccommodations@marsh.com. Marsh is committed to hybrid work, which includes the flexibility of working remotely and the collaboration, connections and professional development benefits of working together in the office. All Marsh colleagues are expected to be in their local office or working onsite with clients at least three days per week. Office-based teams will identify at least one "anchor day" per week on which their full team will be together in person. The applicable base salary range for this role is $132,500 to $265,000.

The base pay offered will be determined on factors such as experience, skills, training, location, certifications, education, and any applicable minimum wage requirements. Decisions will be determined on a case-by-case basis. In addition to the base salary, this position may be eligible for performance-based incentives. We are excited to offer a competitive total rewards package which includes health and welfare benefits, tuition assistance, 401K savings and other retirement programs as well as employee assistance programs.