at UnitedHealth Group in Chicago, Illinois, United States
Job Description
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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life’s best work. SM
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
+ Assist with setting up pharmacy network structure in RxClaim
+ Audit contract loads for adherence to quality measurers and reporting standards
+ Create documentation for standard operating procedures (SOP)
+ Provide Client support on pharmacy claim investigations
+ Audit work of others to identify and process / coordinate correction of loading errors
+ Recommend methods to improve processes used by department
+ Identify gaps and opportunities in network configuration
+ Lead conversations with internal and external team members
+ Serve as lead communicator for overall network configuration processes
+ Provides technical, analytical, and strategic guidance to team members
+ Lead cross-functional quality initiatives centered on improving the network maintenance process
+ Lead cross-training initiatives within the team
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:
+ High School Diploma/GED (or higher) OR 5+ years of experience in managed care or PBM experience (experience can include credentialing providers, provider relations, or provider administration)
+ 3+ years of experience in managed care or PBM experience (experience can include credentialing providers, provider relations, or provider administration)
+ 2+ years of experience working in RxClaim to resolve Pharmacy Network tasks/Benefit setup
+ 1+ years of experience working with Plan Finder including knowledge or direct experience with being part of a process of configuration of inserting pharmacy network data, converting to format, and creating a file to be submitted to the government
+ Expert level of proficiency in MS Excel (formulas, macros, pivot tables, manipulate data, etc.)
Preferred Qualifications:
+ Undergraduate Degree (or higher)
+ Certified Pharmacy Tech (CPhT)
+ Medicare Part D experience
+ Knowledge of pharmacy pricing aspects
+ Knowledge of provider networks and/or affiliations
Soft Skills:
+ Exceptional presentation, written and verbal communication skills
+ Demonstrated prioritization / organizational skills and attention to detail
+ Demonstrated interpersonal and communication skills including telephone / email etiquette
Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
California, Colorado, Connecticut, Nevada, New York, Washington or Rhode Island Residents Only : The hourly range for California, Colorado, Connecticut, Nevada, Washington or New York City residents is $27.07 to $53.08. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
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.
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.
\#RPO #green
