Job Details

Clinical Coding Consulting Manager

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.

The position reports to the Sr Director, Clinical Coding Consulting within the Clinical Consulting department. The Clinical Coding Consulting Manager serves as the supervisor for a defined number of Clinical Pharmacists who primary work as liaison between the Clinical Consultant and the internal adjudication & formulary management system coding teams. This managerial role provides oversight, support and consultative guidance to the assigned Clinical Coding Pharmacists who support OptumRxs clinical consultants, formulary operations, benefit operations management (BOM), information technology, and other internal departments. This individual is relied upon to ensure the assigned team members successfully execute their role in consulting, reviewing, designing & testing the custom formulary & utilization management changes.

Youll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Provides oversight & support to Clinical Coding Pharmacists to help ensure superior, high quality clinical coding for a variety of custom coding formulary builds, corrections, and global projects related to a defined set of custom clients
• Recruit, train and manage new team members to support for new client implementations
• Ensure team members have access & training to the various systems & tools to support custom coding efforts including but not limited to RxClaim, RxBuilder, Showcase, Attachmate and RxClaim batch queries
• Ensure that assigned tasks to team members are completed in the defined time period & meet or exceed client level performance guarantees
• Define & manage custom formulary client assignment to assigned team members
• New client implementation oversight & support for all clinical coding documentation, rule specifications & system design efforts
• Conduct annual performance reviews & establish personal development plans for all assigned team members

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.

Required Qualifications:

• Bachelor of Science in Pharmacy or Pharm D
• Current and unrestricted Pharmacist license (any U.S. state)
• 5+ years of experience working as a Clinical Consultant or Clinical Pharmacist working in Formulary/UM operations or Benefit administration
• 1+ years of clinical client-facing (beyond patients and prescribers) and/or formulary consulting experience
• Experience participating in or leading cross department client implementation projects
• Experience conducting claims/coding research and analysis
• Experience working within a PBM
• Experience working in RXClaim 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 Microsoft Excel skills

Preferred Qualifications:

• Experience using Microsoft Access or other database/query tools
• MBA or equivalent advanced degree
• Experience with Medispan drug classification system
• People leadership experience (direct reports)

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, youll find a far-reaching choice of benefits and incentives. The salary for this role will range from $110,200 to $188,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.