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Job Details
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. The Clinical Consultant serves as the primary liaison between OptumRx clinical operations, professional practice, clinical products and the Clinical Consultant’s assigned Fee-for-Service Medicaid client . The role provides clinical support for OptumRx account management, operations, information technology, and other internal departments. Lead and manage ongoing contract relationships and pharmacy benefit analysis and consultation delivery to Medicaid clients. The Clinical Consultant establishes client relationships and serves as primary point of contact for overall and day-to-day service delivery for clinical pharmacy needs. This individual is relied upon to provide proactive clinical recommendations, information regarding pharmacy trend, clinical programs and products, and industry changes to clients, thereby fostering consultative relationships. This individual also represents client(s) internally and coordinates with other functional areas to implement client initiatives, complete projects, and address ongoing pharmacy service needs. Location: Waterbury, Vermont If you are located in Vermont, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities:
- Provide superior clinical consultation and clinical account management with a focus on client satisfaction, client retention, and trend management
- Collaborate with the client to establish achievable but aggressive clinical program goals, implementation and ongoing management of utilization management programs, improvement in medication adherence rates, improvements in therapy gaps for key chronic disease states, and preferred drug list (PDL) initiatives and support
- Communicate drug information to clients and respond to plan-specific clinical inquiries
- Stay aware of and provide clinical market intelligence to clients
- Identify opportunities for clinical program up-sell and spearhead up-sell to assigned client(s), where contractually appropriate
- Incorporate treatment and practice guidelines into client presentations including up-selling opportunities
- Comprehend and effectively explain formulary and clinical program changes to clients and internal departments
- Effectively manage client objections to new programs and required changes
- Identify and create opportunities to manage trend and add Optum products
- Formulate and deliver client recommendations based on available data and trend
- Deliver clinically sound and fiscally responsible recommendations to clients based on their trend
- Routinely collaborate with account management to provide clinical aspects of client quarterly reviews
- Analyze & interpret benefit designs
- Collaborate in development of strategy as outward facing, dedicated or designated resource for assigned accounts, typically with direct client contact
- Bring innovative ideas that can be scaled across the organization
- Work in a collaborative manner with the Consultant(s) of assigned client(s) while maintaining focus on UHG and Optum strategies and goals
- Clearly communicate analytical and reporting needs to supporting departments
- Help clients be competitive within their market
- Identify opportunities to increase efficiency
- Manages/facilitates custom Pharmacy and Therapeutics (P&T) committees and Drug Utilization Review Board meetings for select clients, per contractual requirements
- Prepare meeting material
- Present recommendations, provide written analysis and respond to questions from the board members
- Review and recommend clinical prior authorization criteria
- Formulate, develop and provide to the P&T Committee recommendations for preferred drugs in each reviewed class
- Implement changes to the PDL and prior authorization requirements which will include modifications to the POS system and all supporting systems and documents
- Serve as the Prior Authorization Call Center Liaison
- Provide education for clients, pharmacists, members and physicians per contractual requirements
- Support sales and marketing including participating in RFP & Finalist activities, per department policies
- Bachelor's degree in Pharmacy or Pharm D
- Current and unrestricted Pharmacist license
- 3+ years of experience working as a licensed pharmacist
- Experience working in a client-facing role with external clients (beyond patients and prescribers)
- Fee-for-Service Medicaid experience
- Experience developing and delivering formal presentations
- Proficient in Microsoft Office and Outlook
- Primary residence in the state of Vermont
- Willing or ability to travel up to 25%
- Clinical account management experience
- Experience working for a PBM and / or Health Plan in a client-facing role
- Experience working with complex public sector and government clients with complex benefit structures
- Experience with transition/implementation of clients
- Formulary Management experience
- DUR experience
About the Company
UnitedHealth Group
Minnetonka, MN, United States
UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are... Read more