Clinical Coding Pharmacist

Davita Inc.; Schaumburg (IL); Remote; USD 89,000 - 177,000; Full time

Job summary

A leading healthcare company seeks a Clinical Pharmacist to support formulary management and coding consultation. The role involves clinical coding support, compliance review, and data analysis, catering to the needs of clinical consultants and internal departments. Ideal candidates have extensive pharmacy experience and strong skills in Excel and clinical coding.

Benefits

Comprehensive benefits package

Incentive and recognition programs

401k contribution

Equity stock purchase

Qualifications

• 3+ years of experience as a clinical pharmacist.
• Current and unrestricted pharmacist licensure.
• Experienced in claims and coding research.

Responsibilities

• Provide consultative guidance for formulary changes.
• Conduct 2ND Level Formulary / UM Claim Research.
• Analyze data and prepare management summaries.

Skills

Clinical pharmacy

Clinical coding

Data analysis

Formulary management

Microsoft Excel

Education

Pharmacist licensure

MBA or advanced business degree

Tools

Microsoft Access

RxClaim

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. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Clinical Pharmacist on the Clinical Coding Consulting team serves as the primary liaison between OptumRx Formulary & Utilization operations, Benefit Operations Management and the Clinical Consultant.

The role provides clinical coding support for OptumRx clinical consultants, benefit operations management (BOM), information technology, and other internal departments. This individual is relied upon to provide custom formulary & utilization management coding consultation & work to the clinical consultant client facing teams on formulary & utilization management set up in the RxClaim adjudication system & related formulary management applications.

Positions in this function provide clinical pharmacy advice and guidance on any or all of the following:

• Research upcoming drug releases and treatment guidelines, develop and maintain pharmacy programs, such as formulary lists, drug utilization review, prior authorization, health outcomes, disease state management, care management, and other specialty programs. May also include presenting at Pharmacy & Therapeutics Committee


• Work on program implementation teams and contribute to business process design and systems set up, trouble shooting and updates


• Review programs for compliance to state, federal and CMS regulations and recommend remediation. Monitor impending legislation for potential impact to current and future programs


• Analyze data and prepare management summaries related to work stream results, performance mgmt. results, audit results, CMS reporting, and client reporting


• Perform quality audits, determine performance gaps and root causes, prepares reports and collaborates on remediation

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Provides consultative guidance for standard & custom formulary changes in RxClaim and RxBuilder


• Conducts 2NDLevel Formulary / UM Claim Research


• Support global Coding Change


• Commercial clinical audit support


• Manage custom formulary coding work post client sign off


• Translate client intent to code - able language for BOM team


• Evaluate / resolve new rule design & conflicts with existing formulary coding


• New Client Implementation coding support for custom formulary / UM programs


• Extracts, evaluates and interprets clinical coding in adjudication & formulary management systems

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:

• Current and unrestricted pharmacist licensure (include state specific if required)


• 3+ years of experience working as a clinical pharmacist


• Intermediate to Advanced Microsoft Excel skills


• Experience conducting claims / coding research and analysis


• Experience working within a PBM


• Experience working in RX Claim or other claims adjudication system

Preferred Qualifications:

• MBA or other related advanced business degree


• Experience using Microsoft Access or other database / query tools


• Experience with custom formulary & utilization management coding consultation


• Experience with Medi-Span drug classification system

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The salary range for this role is $89,800 to $176,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.