Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
The Network Pricing Consultant supports MAC related regulatory requirements and works to develop and enhance processes to create more efficient approaches towards compliance. Network Pricing Consultants conduct various analysis activities in support of network contracting regulations and management strategies. Responsibilities also include managing maintenance on achieved solutions and performance metrics / reporting.
This team is responsible for making sure that we are complaint with state MAC laws regarding pricing and appeals. They meet with the Regulatory Department to discover ways to operationalize state law requirements. They also generate reports and deal with escalated complaints from states DOI and OIC.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Serve as a key resource on complex and / or critical issues
- Collaborate with others to develop policies and procedures and implement solutions that ensure adherence with applicable laws and regulations
- Review and assess regulatory requirements applicable to business units
- Understanding of Pharmacy state regulatory requirements
- Prepare responses on all Pharmacy regulatory inquires and audits
- Maintain proper documentation of policies and procedures, process flows, SOPs, Job Aids, etc.
- Develop project plan and task level tracking to ensure on-time delivery of solutions
- Provide business rules and requirements for IT development of system tools to support new processes and/or enhancements
- Collaborate with the data and reporting team to design and create various internal and external reporting
- Solve complex problems and develop innovative solutions
- Anticipate customer needs and proactively develop solutions to meet them
- Review work performed by others and provide recommendations for improvement
- May lead functional or segment teams or projects
- Provide explanations and information to others on the most complex issues
- Motivate and inspire other team members
You’ll 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.
- Undergraduate degree
- 1+ years of experience working with Regulatory, Legal, Compliance or Contracting
- 1+ years of experience working with Regulatory requirements - developing policies and procedures based on regulatory regulations.
- 2+ years of analytical experience in financial analysis, healthcare pricing, network management, healthcare economics, or related discipline
- 2+ years of experience in documenting policies and procedures, workflows, and tracking critical timelines
- Solid written and verbal communication skills
- Ability to prioritize, coordinate and manage multiple tasks in a fast-paced environment
- Expert level proficiency in MS Excel (formulas, macros, pivot tables, run calculations, create pricing models, create reporting, manipulate data, etc.)
- 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
- 1+ years of experience with provider payment methodologies and healthcare products
- Flexible and able to adapt to new processes
- Self-motivated, self-driven and detail-oriented
- Knowledge of MS Access and Tableau
- Intermediate Level Proficiency with SQL (pull, sort, filter and manipulate data, code, create reporting, etc.)
Careers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you’ll fill far more than prescriptions. As a member of one of our pharmacy teams, you’re empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)
Colorado Residents Only: The salary range for Colorado residents is $64,800 to $116,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.
Job Keywords: Network Pricing Consultant, Regulatory, Legal, Compliance, Contracting, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH, Denver, CO, Little Rock, AR, Orlando, FL, Dallas, TX, Minneapolis, MN, Colorado, Arkansas, Florida, Texas, Minnesota