Position Description: Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work. Positions in this function are responsible for all related aspects of claim system processes and claim business rules. Includes claims systems utilization, capacity analyses / planning and reporting. Includes claims - related business and systems analysis. Ensures data integrity, data security and process optimization. This particular position is for the Maryland Department of Health request for proposal (RFP), Pharmacy Point-of-Sale Electronic Claims Management Services. Employment is contingent upon contract award. Deputy Account / Systems Manager – This role will work out of the OptumRx local facility which will be located within a twenty-file (25) mile radius of the State's offices at 201 West Preston Street, Baltimore, MD 21201. Preference is in Baltimore city limits. Primary Responsibilities:Shall function as the liaison for all system requirements between the client and OptumRx, examples of responsibilities below but not limited to:Document and facilitate benefit design and edits to the claims processing system that provide services to the State's PBM ProgramsTest new programs or modules to be used to manage the PBM ProgramsQuality control of edits to ensure proper functioning within the systemPerform capacity planning and reporting Claims related and business system analysis Responsible for all aspects of quality assurance Create and edit requirements, specifications, cost benefit analysis and recommendations to proposed solutions Facilitate development of process documentation Generally work is self-directed and not prescribedWorks with less structured, more complex issuesServes as a resource to othersWill be 100% dedicated to this Contract.Assists in determining reimbursement methodologies by providing expenditure and utilization data by the National Drug Code (NDC), current version.Will be located at Contractor's Local Facility.
Required Qualifications:Bachelor's degree (or higher) in Computer Science, Engineering , or equivalent 2+ years of experience in an Account Management position 3+ years of experience serving as a liaison between technical and operational teams 3+ years of experience in testing, implementation, and maintenance of a large-scale automated application similar to the proposed system for a government or private sector Previous experience in creating use cases, requirement analysis documents, detail specification documents, resolving production problems and developing user acceptance test plans and knowledge of development life cycles Preferred Qualifications:Fee For Service Medicaid or Medicaid Managed Care experiencePBM experienceImplementation experienceClient facing or account management experience Analytical skillsSoft Skills: Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product Physical Requirements and Work Environment: Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouseOffice environmentOptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do. If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing your life's best work.SM 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. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: UnitedHealth Group, UHG, OptumRx, Client Liaison, Maryland, The Department of Health, PBM, Baltimore, MD, PBM, managed care, managed medicare, healthcare, quality assurance, testing, medicaid, account management, Deputy Account-Systems Manager
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.