Combine two of the fastest-growing fields on the planet with culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliable. There's no room for error. Join us and start doing 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.
- Dedicated OptumRx Clinical SME(s) that would ensure / oversee / monitor:
- Understand the retail pharmacy, prescriber eRx & ePA workflows to ensure that PCMS is meeting all stakeholder requirements
- PCMS Messaging enhancements to make the formulary positioning more clear by LOB to the EMRs
- Unbreakable package logic is current and functioning as expected.
- Logic created and updated entirely by M&R.
- Proxy NDC logic is current and functioning as expected.
- Recently Lisinopril rejecting as "not covered"
- Alternatives presented is functioning as expected.
- Opioid messaging logic is current and functioning as expected.
- RTB copay vs. Production Pharmacy claim accuracy
- As new functionality is rolled out (e.g. Specialty Pharmacy / Home Delivery / Retail 90 / Diagnosis Code submission) that they are kept current and functioning as expected.
- As RxClaim MOD enhancements impact production claims to interpret and bring back any / all impacts to trial claim functionality that may impact PCMS.
- Dedicated OptumRx Clinical and/or Reporting SME(s) that would ensure / oversee / monitor:
- ePA completely lacks ORx input on how to interpret PAS data and provide guidance on the best approach to gauge product performance
- SMEs dedicated to interpret RxClaim extracts and PAS extracts and be able to link back to PCMS activity in the most efficient / accurate / effective manner
- SMEs dedicated to remove / prevent 'blockers' to reporting asks from the various LOBs
- The correct reporting to meet Client / Market / Enterprise value is visible
- Quality assurance of the metrics housed in various reports match each other (e.g. Operations Report vs. Unique NPI Report vs. UHN Executive all have different #'s for UPEs)
- Reduce the dependence on the Business intellectual inputs, reporting prioritization and escalating those reports that have missed deadlines
- Initiating net new deep dives into strategic areas of opportunity that assess the impact of PCMS. These may be one time analysis, or analysis that that serve an ongoing need. If ongoing, the PCMS agile reporting team may be able to take ownership.
- Meaningful Utilizers: Assessment and metric definition generation of an "Active PCMS Utilizer"
- Pricing Accuracy: Evaluation of the PCMS price displayed for a target or alternative medication compared to the price the member pays at the pharmacy.
- Net Savings (post rebate): Determine the post rebate claims savings impact of PreCheck MyScript for the target drug and alternative (filled) drug. Note that this may be positive - moving to a preferred product or negative - moving to a generic medication.
- Reject Rates: Impact assessment on the rate of prescriber prescriptions that reject at the pharmacy
- Behavior Change: Assessment of when a prescriber selects a preferred alternative and starts using that preferred alternative as the target prescription for future prescriptions
- Enhancement ROI: Financial impact assessment of forthcoming enhancements, in particular, Home Delivery and BriovaRx
- Clinical Alert (opioid): Impact assessment of clinical alerts on prescriber behavior change, including adjusting the target medication and/or pursuing preferred alternatives
- NPS: Assessment of how NPS is influenced for both members and prescribes
- Provider Value: Define the value of each provider that uses the tool
- 2+ years of RxClaim experience
- 3+ years Pharmacy / healthcare industry experience
- Advanced skills with Microsoft Excel (Pivot Tables, Formulas, creating reports)
- Undergraduate degree or equivalent related experience
- 1 year ePA or PA experience (ex: PAS)
- Working knowledge of relational databases, database structures, data mining
- SQL / SAS experience
- Experience in data manipulation, reporting and analysis
- Willingness to identify and dig into trend / abnormalities / interesting occurrences in the data; detail oriented
- Ability to summarize and communicate findings to a broad audience
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to 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: MyScript, Irvine, CA, California, Telecommuter, Telecommute, Remote, Work from home