The job below is no longer available.

You might also like

in Newark, NJ

  • Starting at $38.46
    Verified per hour
    Taïm 4h ago
    Fast response10.1 mi Use left and right arrow keys to navigate
  • $22
    est. per hour
    Burger King 2d ago
    Urgently hiring6.6 mi Use left and right arrow keys to navigate
  • $50
    est. per hour
    Seniornest 4h ago
    Urgently hiring10.9 mi Use left and right arrow keys to navigate
  • $85,000
    Verified per year
    Lidl 4h ago
    Urgently hiring15.8 mi Use left and right arrow keys to navigate
  • U.S. Navy 30d ago
    Urgently hiring5.4 mi Use left and right arrow keys to navigate
Use left and right arrow keys to navigate
Hours Full-time, Part-time
Location Newark, NJ
Newark, New Jersey

About this job

UnitedHealth Group is working to create the Healthcare system of tomorrow and you can help. Already Fortune 6, we are totally focused on innovation and change.  We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.
 
Through our family of businesses and a lot of inspired individuals, we're building a high-performance Healthcare system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant and built for speed.  Join with us and start doing your life’s best work.(sm)
 
The Health Plan Pharmacist Account Manager will work on the Northeast Regional team serving as the primary pharmacy point of contact for overall and day-to-day service with local New Jersey C&S UHC plan.
 
This is a work from home opportunity with travel to meetings in office as required.
 
 
Primary Responsibilities:

Build and maintain client relationships and serve as the primary point of contact for overall and day-to-day service with local UHC plan
Build strong working relationships with Plan CEO, COO, CFO and Medical Director
Assist plan on all pharmacy related activities including clinical program development and improving member satisfaction
Responsible for understanding and assuring compliance with the state contract and the rules governing pharmacy (formulary / PDL, UM, member communications, etc.)
Accountable for creation and maintenance of state specific polices
Service as the SME SPOC for benefit and coding requirements and responsible for communication to appropriate internal stakeholders for implementation
Develop a strong working knowledge of health plan operations (compliance, finance, encounters, claims adjudications, networks, clinical, case management, HEDIS measures, etc.)
Work with internal partners to complete projects and address on-going pharmacy service needs of the plan
Conduct and manage outcomes of various studies that include analyzing, reviewing, forecasting, trending and presenting information for operational and business planning
Communicates pharmacy program changes with the assigned health plans key departments
Support Plan short and long term operational / strategic business activities by maintaining operational information
Attend State Medicaid meetings and build relationship with the State pharmacy team
Attend state pharmacy and health plan association meeting and build relationships
Responsible for the timely submission of accurate pharmacy reports and deliverables required of the health plan
Support the assigned health plans Grievances Department in the processing of grievances, appeals, fair hearings, etc., as defined by the health plans process to ensure a timely decision by the plan Medical Director
Support assigned health plans Health Services, Case Management and Behavioral Health areas regarding targeted members with specific pharmacy concerns

Requirements

Primary Qualifications:

Undergraduate degree or equivalent experience
Current, unrestricted Pharmacist license as required by contract in the state of NJ
Proficiency in Microsoft Office Suite, including Word, Excel and PowerPoint
A minimum of 3 years of Clinical Pharmacy, Sales or Account Management experience or combination
A minimum of 3 years of experience in Managed Care Pharmacy either in a Health Plan or PBM
At least 1 year of direct experience with Medicaid / Medicare plans
Experience with Pharmacy Utilization Review
Understanding pharmacy trends
Understanding of health plans to include PBM contracts and pricing
Understanding and interpretation of state contract language
Experience building and maintain client relationships and networking
Experience developing and implement clinical program to reduce trend or improve member experience
Demonstrated ability to assist with focusing activities toward a strategic direction
Ability to develop tactical plans, drive performance and achieve targets
Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)
 
 
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: Pharmacist, Pharmacy, Health Care, Medicaid, Medicare, HEDIS, NCQA, Managed Care, Clinical, Work at Home, New Jersey, NJ, Trenton, Camden, Newark, Telecommute, Telecommuter, Telecommuting, Remote