16 days old

Specialty Drug Ideation Director, Payment Integrity - Telecommute - 935451

Eden Prairie, MN 55344 Work Remotely
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  • Job Code
    935451

Do you love the excitement of a fast-paced, high-growth organization? If so, a career at Optum, part of the UnitedHealth Group family of businesses will allow you to serve almost all dimensions of the health system from those who diagnose and treat patients to those who pay for care, deliver health services and those who supply the cures. Optum brings together some of the greatest minds and most advanced ideas on where health care must go in order to reach its fullest potential. Join us and learn why there is no better place to do your life's best work.(sm)

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As a Specialty Drug Ideation Leader, you will be responsible for developing and implementing specialty drug related Payment Integrity solutions for our Commercial clients. You will direct teams driving this work and lead dialogue related to specialty drug cost reduction opportunities and risks.

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Youll enjoy the flexibility to telecommute* from anywhere within United States as you take on some tough challenges.

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Primary Responsibilities:

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  • Oversee the ideation function that identifies specialty drug related medical cost savings opportunities using data and clinical perspective and manage the related portfolio of solutions to maximize client value delivery
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  • Participate in analytical, investigative, and other fact-finding work in support of new concept development
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  • Establish strong client and matrix partner relationships to define, align, and deliver payment integrity solutions for clients
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  • Provide executive level program updates and manage Optum team escalations
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  • Influence client leadership to adopt new ideas, approaches, and/or products
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  • Influence specialty drug product strategy and recommend changes to current product development procedures based on market research and new trends
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  • Support specialty drug related sales efforts with prospective clients
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  • Operate as an industry thought leader and Payment Integrity SME
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Youll 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.

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Required Qualifications:

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  • Doctor of Pharmacy degree or equivalent experience with a Bachelors or Masters degree in Pharmacy
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  • Currently holds an active license of an US Board of Pharmacy as Registered Pharmacist
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  • 2+ years of payer or vendor Payment Integrity experience with knowledge of billing, coding, and auditing both medical and pharmacy claims
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  • Working knowledge of CMS rules and regulations and knowledge of procedure and diagnosis codes (CPT, ICD-10 coding, HCPCS and DRGs)
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  • Strong computer skills: Access, Excel, Visio, PowerPoint
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  • Ability to travel up to 20% (limited travel)
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
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Preferred Qualifications:

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  • 10+ years of experience in the health care industry (Medicare, Medicaid, Commercial) with deep exposure to Payment Integrity
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  • 2+ years of experience working in a matrixed environment and handling tight deadlines
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  • Strong clinical knowledge for both medical and pharmacy (disease and treatments)
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  • Knowledge of statistical methods used in the evaluation of healthcare claims data
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  • Basic level proficiency with analytics and information research knowledge
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  • Highly collaborative and consultative style with ability to establish credibility quickly with all levels of management across multiple functional areas
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  • Self-managed, self-starter with the ability to support multiple concurrent projects and meet tight delivery timelines
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  • Strong project management approach with excellent critical thinking and problem-solving skills
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If the hired individual resides in Florida (office based or telecommuting) this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five years.

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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)

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Colorado Residents Only: The salary range for Colorado residents is $110,200 to $211,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

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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.

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

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Job Keywords: Specialty Drug Ideation Director, Payment Integrity, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH

Posted: 2021-06-03 Expires: 2021-07-03

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Specialty Drug Ideation Director, Payment Integrity - Telecommute - 935451

UnitedHealth Group
Eden Prairie, MN 55344

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