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Health Plan Pharmacist Account Manager - Warwick, RI

UnitedHealth Group

Warwick, RI
Job Code:
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Job Details

Health Plan Pharmacist Account Manager - Warwick, RI(Job Number:723207)

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 Rhode Island C&S UHC plan.
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

Job Clinical Pharmacy Acct Mgmt
Primary Location US-RI-Warwick
Other Location 
Organization UHN Network Pharmacy
Schedule Full-time
Number of Openings 1
Apply on the Company Site

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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