Change Healthcare-posted 22 days ago
$23 - $42/Yr
Full-time • Entry Level
Remote • Dallas, TX
5,001-10,000 employees

This position is National Remote. You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. For all hires in Minneapolis, Virginia, Maryland, or Washington, D.C. area, you will be required to work in the office for a minimum of four (4) days per week. 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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. Join a high-impact team that sits at the intersection of clinical pharmacy, operations, and technology. In this role, you'll operationalize custom Utilization Management (UM) criteria within our UMCS (Utilization Management Criteria System) platform, partner closely with clinical consultants and pharmacists, and drive process improvements and automation-including early applications of AI-to enhance speed, accuracy, and scale across our UM workflows. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm CST. It may be necessary, given the business need, to work occasional overtime. We offer 8-12 weeks of paid training. The hours of training will be based on your schedule.

  • Partner with clinical consultants to translate client requirements into UM guidelines and operationalize custom UM criteria in UMCS accurately and on time.
  • Support pharmacists by configuring and validating UM criteria in UMCS efficiently and with strong documentation.
  • Build and maintain operational visibility: compile monthly reports, guideline compiles, and trackers to streamline inter departmental communications.
  • Present with polish: share screen during high-profile meetings and seamlessly access, navigate, and present the right materials at the right moment.
  • Improve processes: identify bottlenecks and assist in the design and implementation of process improvements that enhance efficiency and quality.
  • Deliver ad hoc analysis and special projects with clear structure, timelines, and stakeholder updates.
  • Analyze complex drug datasets including Medi-Span updates and GPI (Generic Product Identifier) structures; synthesize insights to inform UM decisions.
  • Manage projects end to end, coordinating cross-functional dependencies through completion.
  • Champion automation: propose and prototype ideas to automate recurring tasks; document and measure impact.
  • Lead team education on AI: develop light training/enablement for practical AI use cases and responsible usage.
  • Support validation/implementation of AI and automation solutions within UM operations (pilots, UAT, SOP updates).
  • High School Diploma / GED
  • Certified Pharmacy Technician (CPhT) OR 1+ years of managed care pharmacy experience
  • Must be 18 years of age or older
  • Proficiency with Microsoft Office (Word, Excel, Outlook)
  • Communication and stakeholder management skills
  • Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am - 5pm CST. It may be necessary, given the business need, to work occasional overtime
  • Experience with RxClaims
  • Experience with Project management (formal or practical)
  • Experience with Prior Authorization claims adjudication processes
  • Knowledge of Medicare Part D and Commercial lines of business
  • UMCS (Utilization Management Criteria System)
  • Excel (lookups, pivots, data cleansing)
  • RxClaims, Medi Span data
  • SharePoint/Teams or equivalent collaboration tools
  • Basic AI/automation enablers (e.g., Power Automate, copilots).
  • Ability to keep all company sensitive documents secure (if applicable)
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
  • All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
  • 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).
© 2024 Teal Labs, Inc
Privacy PolicyTerms of Service