As one of the largest pharmacy benefits managers in the United States, UnitedHealth Group provides a professional culture where you're empowered and encouraged to exceed the expectations of our members, with better schedules than retail and more reach than any hospital. Join us and start doing your life's best work.(sm) The Director of Clinical Pharmacy will assume a leadership role in the planning, development and implementation of pharmacy and disease management programs and processes that result in, decreased hospital and emergency room utilization, improved patient care, and maximize Pay for Performance revenue. This role will be accountable for planning, developing and implementing physician education programs related to new treatment modalities for various disease states, HEDIS / P4P, CMS Star Ratings, Medicare Part B and & D drugs, and pharmacy utilization management best practices. Primary Responsibilities:In collaboration with Medical Directors, executes and implements intervention strategies at various physician practices to manage pharmacy utilization related to pharmacy risk pools and generic incentive programsWill participates in Joint Operating and Medical Management Committees, designs and implements cost / utilization and trend analysis reports for pharmacy utilization - provided by health plans, including recommendations for physiciansManages daily authorizations for appropriateness of various injectable drugs, IV solutions, and chemotherapy, including the development of policies and procedures for appropriate optimal cost savings treatment plansIdentifies potential vendors and assists the Network Management Department with contract negotiationsServes as Co - Chair of Monarch Pharmacy & Therapeutics (P&T) CommitteeServes as a clinical / pharmacy subject matter expert for Clinical Service's case managers including identifying high volume / high cost pharmacy utilizing members and assisting with the development of case management planningCollaborates with High Risk Touch Teams to ensure effective medication reconciliation and patient education for high risk patients in order to decrease readmissions and avoidable emergency room visitsContributes as valuable contributor for the Quality Improvement Committee, Utilization Management Committee, and other meetings such as Credentialing and Peer Review Committee, Readmission Rounds, Fee For Service Committee, ER Subcommittee, Vaccine Subcommittee, and MCR Committee as requestedCo - leads the development and implementation of Disease Management Programs, (CHF, COPD, Diabetes, Renal, HTN) oversees the day-to-day program processes, and chairs the Disease Management SubcommitteeIn collaboration with Medical Directors, develops performance metricsTracks and trends outcomes and designs and / or implements operational changes to affect performance of each ProgramMaintains a working knowledge of changes in pharmacy practice, including pharmacy laws and drugs, and applies this knowledge in the performance of daily activitiesIdentifies opportunities for improvement and provides additional orientation, training and skill development to internal staff and external customers on an ongoing basisParticipates in the Clinical Services Medical Management Team and collaborates with the CMO, Medical Directors and Clinical Directors in all strategic planning, including establishing annual departmental goals and objectivesUnder the direction of the CMO and in collaboration with the Medical Directors and Clinical Affairs Directors, develops and coordinates the implementation of Pharmacy medical management processes, policies and procedures to assure that medically necessary services are delivered in an optimally cost and quality efficient mannerIn partnership with Medical Directors and Clinical Affairs Directors, identifies areas of over or under pharmacy utilization, often through collaboration with finance and decision support departments. In conjunction with the CMO and the Clinical Services Medical Management Team develops and implements corrective action plans resulting in required process changes and outcomes when aberrant trends are identifiedPromotes a culture of open, clear communication and collaboration interdepartmentally and intra - departmentally and with external customers and organizationsConsistently supports compliance by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance, and adhering to applicable federal, state and local laws and regulations, accreditation and license requirements (if applicable), and current MHC policies and proceduresContributes to planning efforts as needed, and attends and / or participates in community Health FairsManages direct reports by overseeing individual business and development goals, performing and entering annual performance reviews, managing staff reimbursement and other departmental budgetary issues as neededServes as liaison and channel of communication for Pharmacy related issues between the CMO and committees, external customers and organizations, and the medical and administrative staff
Required Qualifications:Pharm D degreeActive, unrestricted Pharmacist license in California 5+ years of managed care medical management experience3+ years of supervisory experience Strong working knowledge of Medicare Part B and Medicare Part D Preferred Qualifications:Experience with IPAs, medical groups or HMOs Completion of an accredited ASHP PGY1 Residency What is the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Monarch HealthCare joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do 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. Job Keywords: Medical Management, Clinical, Licensed Pharmacy, Pharmacist, Pharm D, Medicare
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.