Clinical Pharmacy Consultant: Formulary & Utilization Expert

Optum, a UnitedHealth Group Company; Makati; On-site; PHP 600,000 - 1,200,000; Full time

Benefits offered by this job

Market competitive pay levels

Retirement plan

Medical plan (HMO) from Day 1

Dental, medical, and optical reimburse

Life and disability insurance

Paid time-off benefits

Sick leave conversion

Tuition fee reimbursement

Employee assistance program (EAP)

Merit increases

Employee recognition

Training and staff development

Employee referral program

Volunteerism opportunities

All statutory benefits

Job summary

Optum, a UnitedHealth Group company, seeks a Clinical Pharmacist on the Clinical Coding Consulting team in Makati. You will bridge Formulary & Utilization Operations with Clinical Consultants and BOM, delivering coding guidance and support for formulary setups in RxClaim and related apps.

You will perform pharmacology and coding analyses, support client implementations, and translate business needs into codable solutions while collaborating with internal teams.

Qualifications

• Bachelor of Science in Pharmacy (BS Pharmacy) or Doctor of Pharmacy (PharmD).
• Must be a Licensed Pharmacist.
• 2–5 years of pharmacy-related experience in PBM/healthcare settings.
• Strong understanding of PBM concepts, formulary management, and utilization management.
• Experience conducting pharmacy claims research, coding analysis, and issue resolution.
• Experience using RxClaim or other pharmacy claims adjudication systems preferred.
• Strong analytical, problem-solving, communication, and stakeholder management skills.
• Intermediate to advanced Microsoft Excel proficiency.
• Proficient in MS Office and Windows environments.
• Ability to translate business and client requirements into coding solutions.

Responsibilities

• Provide consultative guidance for standard and custom formulary changes in RxClaim, RxBuilder, and related apps.
• Conduct second-level formulary and utilization management claim research.
• Provide implementation clinical coding support for BDS, cBDT, RxConstruct inquiries.
• Support GPI reclassifications and global coding changes.
• Provide commercial clinical audit support.
• Manage custom formulary coding work after client sign-off.
• Translate client intent into codable language for BOM team.
• Evaluate and resolve new rule designs and conflicts in formulary coding.
• Support new client implementations involving custom formulary programs.
• Extract, evaluate, and interpret clinical coding within adjudication systems.

Skills

Pharmacist license

PBM knowledge

Excel proficiency

Communication skills

Stakeholder mgmt

Clinical coding

RxClaim experience

RxBuilder/RxAuth familiarity

Education

BS Pharmacy or PharmD

Tools

RxClaim

RxBuilder

RxAuth

RxInteract

Job description

Optum, a UnitedHealth Group company, seeks a Clinical Pharmacist on the Clinical Coding Consulting team in Makati. You will bridge Formulary & Utilization Operations with Clinical Consultants and BOM, delivering coding guidance and support for formulary setups in RxClaim and related apps.

You will perform pharmacology and coding analyses, support client implementations, and translate business needs into codable solutions while collaborating with internal teams.