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FMS Lead - Irvine, CA Preferred or Telecommute

UnitedHealth Group

Irvine, CA
Job Code:
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Job Details

FMS Lead - Irvine, CA Preferred or Telecommute(Job Number:715652)

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(SM)


Overview of Industry Relations Business (IRB) Support of FMS Business Segment

The Director, Industry Relations Business requires a clinical background to support clients in the growing Formulary Management Services (FMS) business segment, including identification and quantification of opportunities to maximize pharmaceutical rebate revenues and evaluation of these opportunities via financial therapeutic class models using client-specific actual claims data.


Primary Responsibilities: Including FMS Support Services

  • Identify opportunities to maximize pharmaceutical rebates for Core and Custom formulary clients in the Formulary Management Services (FMS) business segment

  • Apply clinical and business knowledge to prepare quarterly lists of therapeutic classes for financial modeling and create the market baskets to permit importation of client claims data into client-specific therapeutic class models

  • Create and manipulate therapeutic class models to quantify the financial effects on rebate revenues using alternate drug formulary status scenarios

  • Verify drug formulary status in both the calendar quarter of the claims data in the financial model as well as the current quarter for the financial projections

  • Determine rebate rates and conditions applicable to each therapeutic class model for the calendar quarter of the claims data in the model and for prospective scenarios

  • Convert therapeutic class models to format for client presentation

  • Explain therapeutic class financial models to client-facing team members in preparation for client meetings including quarterly Rebate Round Table (RRT) presentations

  • Create client-specific Excel tables of the top 20 WAC price changes in the preceding 12-month period

  • Qualify and quantify client-specific rebate billing discrepancies discovered in the process of therapeutic class modeling and resolve in collaboration with client-facing team members and Rebate Management

  • Negotiate with pharmaceutical manufacturers to obtain rebate rates, terms, and conditions consistent with the business strategy developed by the IRB team


Job Network Pricing
Primary Location US-CA-Irvine
Other Location US-CO-Denver, US-MN-Minneapolis, US-FL-Orlando, US-IL-Chicago, US-WA-Seattle, US-NY-New York, US-CT-Hartford, US-CA-San Francisco
Organization OptumRx Industry Reltn & Trade
Schedule Full-time
Number of Openings 1
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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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