You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. When you're setting the pace for change, it's not only challenging, it's exhilarating. We're building new health care solutions right and left and shaping the system as we go to help millions live healthier lives. That's why we need Clinical Program Business Analysts who can keep up to ensure Clinical Programs offered by OptumRx are compliant and competitive. When you join us, you'll drive processes and improvement initiatives that have an impact on healing the health system. Sound like your kind of challenge? Join a Fortune 6, industry leader and find out how you can be a part of something life changing for millions. This is a challenging role that creates an opportunity to grow and develop while doing your life's best work.(sm) Primary Responsibilities:Oversee the design and development of compliant Government Program Clinical ProgramsDrive standard interpretation and implementation of Government Program regulatory requirements across cross-functional development and operational teamsProvide consultation and oversight to the teams associated with Government Program Prior Authorizations to drive compliance, quality and efficiency The question is how effective can you be in interpreting and analyzing regulatory requirements to provide consultation, education, guidance, support, and oversight to functional areas engaged in development and operational delivery of Clinical required programs and authorizations for Medicare Part D, Medicaid, and HIM clients? The challenge will be to manage multiple projects simultaneously, while adapting to ongoing changes in regulatory requirements.
Required Qualifications:High School Diploma / GED or higher level of education2+ years of PBM or Managed Care Organization experience with a strong clinical backgroundExperience in analysis of business process and workflow and providing an evaluation, and/or process improvement recommendations Experience in working collaboratively in a cross-functional team environmentPreferred Qualifications: Knowledge and experience in interpreting regulatory clinical program requirements to build compliant clinical programsExperience with OptumRx's claim adjudication system's prior authorization functionalityExperience in Medicare Part D, Medicaid, and/or HIM clinical programsCareers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you'll fill far more than prescriptions. As a member of one of our pharmacy teams, you're empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing 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: Medicare, Part D, Medicaid, HIM, Government, Guidance, Regulatory, Clinical, Analysis, analyst, data analysis, business analysis, business requirements, authorization, telecommute
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.