Clinical Coding Consultant Pharmacist - Remote Job Houston Texas USA,Healthcare

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.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The Clinical Pharmacist on the Clinical Coding Consulting team serves as the primary liaison between Optum Rx's Formulary & Utilization operations, Benefit Operations Management and the Clinical Consultant. The role provides clinical coding support for Optum Rx 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.

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, RxBuilder & related clinical applications (RxAuth, Rx Interact)
Conducts 2ND Level Formulary/UM Claim Research
Implementation clinical coding support for BDS/cBDT/Rx Construct questions
GPI Reclass support/global Coding Change Support Drug utilization management
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:

Bachelor of Science in Pharmacy or PharmD
Current and unrestricted Pharmacist license (any U.S. state)
2+ years of experience working as a Clinical Consultant or Clinical pharmacist working in Formulary/UM operations or Benefit administration
Experience conducting claims/coding research and analysis
Experience working within a PBM
Experience working in RX Claim or other claims adjudication system
Ability to navigate MS Office and a Windows based environment and the ability to create, edit, save, and send documents utilizing Microsoft Word; ability to navigate Outlook and conduct Internet searches
Intermediate to Advanced Proficiency with Microsoft Excel

Preferred Qualifications:

MBA or other related advanced business degree
Experience using Microsoft Access or other database/query tools
Experience with Medi-Span drug classification system
Client-facing experience (beyond patients and prescribers)

* All employees working remotely will be required to adhere to United Health Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and…