UnitedHealth Group is working to create the Healthcare system of tomorrow and you can help. Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good. Through our family of businesses and a lot of inspired individuals, we're building a high-performance Healthcare system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant and built for speed. Join with us and start doing your life's best work.(sm) The Health Plan Pharmacist Account Manager will work on the Northeast Regional team serving as the primary pharmacy point of contact for overall and day-to-day service with local Rhode Island C&S UHC plan. Primary Responsibilities:Build and maintain client relationships and serve as the primary point of contact for overall and day-to-day service with local UHC plan Build strong working relationships with Plan CEO, COO, CFO and Medical Director Assist plan on all pharmacy related activities including clinical program development and improving member satisfaction Responsible for understanding and assuring compliance with the state contract and the rules governing pharmacy (formulary / PDL, UM, member communications, etc.) Accountable for creation and maintenance of state specific polices Service as the SME SPOC for benefit and coding requirements and responsible for communication to appropriate internal stakeholders for implementation Develop a strong working knowledge of health plan operations (compliance, finance, encounters, claims adjudications, networks, clinical, case management, HEDIS measures, etc.) Work with internal partners to complete projects and address on-going pharmacy service needs of the plan Conduct and manage outcomes of various studies that include analyzing, reviewing, forecasting, trending and presenting information for operational and business planning Communicates pharmacy program changes with the assigned health plans key departments Support Plan short and long term operational / strategic business activities by maintaining operational information Attend State Medicaid meetings and build relationship with the State pharmacy team Attend state pharmacy and health plan association meeting and build relationships Responsible for the timely submission of accurate pharmacy reports and deliverables required of the health plan Support the assigned health plans Grievances Department in the processing of grievances, appeals, fair hearings, etc., as defined by the health plans process to ensure a timely decision by the plan Medical Director Support assigned health plans Health Services, Case Management and Behavioral Health areas regarding targeted members with specific pharmacy concernsIf you are located in Warwick, Rhode Island, you will have the flexibility to telecommute* as you take on some tough challenges. This position will work in the Warwick, RI office with the ability to telecommute 2 days a week.
Required Qualifications:Undergraduate degree or equivalent experience Current, unrestricted Pharmacist license as required by contract Proficiency in Microsoft Office Suite, including Word, Excel and PowerPoint 3+ years of Clinical Pharmacy, Sales or Account Management experience or combination thereof 3+ years of experience in Managed Care Pharmacy either in a Health Plan or PBM 1+ year of direct experience with Medicaid / Medicare plans Experience with Pharmacy Utilization Review Understanding of health plans to include PBM contracts and pricing Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from othersPreferred Qualifications:Understanding pharmacy trends Understanding and interpretation of state contract language Experience building and maintain client relationships and networking Experience developing and implement clinical program to reduce trend or improve member experience Demonstrated ability to assist with focusing activities toward a strategic direction Ability to develop tactical plans, drive performance and achieve targetsCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm) *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: Pharmacist, Pharmacy, Health Care, Medicaid, Medicare, HEDIS, NCQA, Managed Care, Clinical, Work at Home, Work from Home, WAH, WFH, Warwick, RI, Rhode Island
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.